Prolonged inhibition of interleukin-6 mediated signaling

ABSTRACT

Polypeptides are provided directed against IL-6R at specific dose ranges and dosing schedules that result in a prolonged effect on IL-6 mediated signaling. In particular, the invention provides pharmacologically active agents, compositions, methods and/or dosing schedules that have certain advantages compared to the agents, compositions, methods and/or dosing schedules that are currently used and/or known in the art, including the ability to dose less frequently or to administer lower doses to obtain equivalent effects in inhibiting IL-6 mediated signaling.

RELATED APPLICATIONS

This application is a divisional of U.S. application Ser. No.14/345,702, filed Mar. 19, 2014, which is a national stage filing under35 U.S.C. § 371 of international application PCT/EP2012/068765, filedSep. 24, 2012, which was published under PCT Article 21(2) in English,and claims the benefit under 35 U.S.C. § 119(e) of U.S. provisionalapplication Ser. No. 61/538,500, filed Sep. 23, 2011, U.S. provisionalapplication Ser. No. 61/604,774, filed Feb. 29, 2012, and U.S.provisional application Ser. No. 61/664,337, filed Jun. 26, 2012, thedisclosures of which are incorporated by reference herein in theirentireties.

FIELD OF THE INVENTION

The present invention relates to methods for inhibiting IL-6 mediatedsignaling for prolonged periods of time. More specifically, the presentinvention provides polypeptides directed against IL-6R at specific doseranges for inhibiting IL-6 mediated signaling for prolonged periods oftime.

BACKGROUND OF THE INVENTION

Interleukin-6 (IL-6), originally identified as a B cell differentiationfactor (Hirano et al. 1985, Proc. Natl. Acad. Sci. USA, 82: 5490-4; EP0257406), is a multifunction cytokine that has a wide range ofbiological activities in various target cells and regulates—amongstothers—immune responses, acute phase reactions, hematopoiesis, bonemetabolism, angiogenesis, and inflammation (Nishimoto et al. 2006, Nat.Clin. Pract. Rheumatol. 2: 619-626). The interaction of IL-6 with IL-6receptor (IL-6R) (Yamasaki et al. 1988, Science 241: 825-8; EP 0325474),an 80-kDa ligand-binding chain (IL-6R α-chain, or CD126), results in theformation of the IL-6/IL-6R complex. This complex binds to the membraneprotein gp130 (Taga et al. 1989, Cell 58: 573-81; EP 0411946), a 130-kDanon-ligand-binding signal-transducing chain (IL-6R (3-chain, or CD130)on a target cell, which transmits various physiological actions of IL-6.In cells with sufficient membrane-bound IL-6R, IL-6 binds to thesereceptors, the IL-6/IL-6R complex induces homodimerization of the gp130molecule, and a high-affinity functional receptor complex of IL-6,IL-6R, and gp130 is formed (Hibi et al. 1990, Cell 63: 1149-1157). Incells that do not express sufficient cell-surface IL-6R, IL-6 signaltransduction starts with the binding of IL-6 to the free, soluble formof IL-6R (sIL-6R), which lacks the membrane and intracytoplasmic portionof the 80-kDa membrane-bound IL-6R molecule (Taga et al. 1989, Cell 58:573-581; Hibi et al. 1990, Cell 63: 1149-1157). Thus, eithermembrane-bound or soluble IL-6R can mediate IL-6 signal into cells, aslong as the cells express gp130. Considerable amounts of sIL-6R areobserved in serum and body fluids (Usón et al. 1997, J. Rheumatol. 24:2069-2075; Desgeorges et al. 1997, 24: 1510-1516), and sIL-6R may playphysiologic roles as well as having a pathologic role inimmune-inflammatory and malignant diseases (Rose-John et al. 2006, J.Leukocyte Biol. 80: 227-236). Processes mediated via sIL-6R areindicated as trans-signaling.

Deregulation of IL-6 production is implicated in the pathology ofseveral autoimmune and chronic inflammatory proliferative diseaseprocesses (Ishihara and Hirano 2002, Biochim. Biophys. Acta 1592:281-96). IL-6 overproduction and signaling (and in particulartrans-signaling) are involved in various diseases and disorders, such assepsis (Starnes et al. 1999, J. Immunol. 148: 1968) and various forms ofcancer such as multiple myeloma disease (MM), renal cell carcinoma(RCC), plasma cell leukaemia (Klein et al. 1991, Blood 78: 1198-204),lymphoma, B-lymphoproliferative disorder (BLPD) and prostate cancer.Non-limiting examples of other diseases caused by excessive IL-6production or signaling include bone resorption (osteoporosis) (Roodmanet al. 1992, J. Bone Miner. Res. 7: 475-8; Jilka et al. 1992, Science257: 88-91), cachexia (Strassman et al. 1992, J. Clin. Invest. 89:1681-1684), psoriasis, mesangial proliferative glomerulonephritis,Kaposi's sarcoma, AIDS-related lymphoma (Emilie et al. 1994, Int. J.Immunopharmacol. 16: 391-6), inflammatory diseases and disorder such asrheumatoid arthritis (RA), systemic onset juvenile idiopathic arthritis(JIA), hypergammaglobulinemia (Grau et al. 1990, J. Exp. Med. 172:1505-8); Crohn's disease, ulcerative colitis, systemic lupuserythematosus (SLE), multiple sclerosis, Castleman's disease, IgMgammopathy, cardiac myxoma, asthma (in particular allergic asthma) andautoimmune insulin-dependent diabetes mellitus (Campbell et al. 1991, J.Clin. Invest. 87: 739-742).

As a consequence, inhibitors of IL-6 induced signaling have attractedmuch attention in the past (Hirano et al. 1990, Immunol. Today 11:443-9). Polypeptides specifically binding to IL-6 (Klein et al. 1991,Blood 78: 1198-204; EP 0312996), IL-6R (EP 0409607) or gp130 (Saito etal. 1993, J. Immunol. Methods 163: 217-223; EP 0572118) proved toexhibit an efficient inhibitory effect on IL-6 functioning. Differentantibodies and antibody fragments directed against human IL-6, againsthuman IL-6R and against human gp130 protein for the prevention andtreatment of IL-6 related disorders have been described. Examples aretocilizumab (Woo et al. 2005, Arthritis Res. Ther. 7: 1281-8; Nishimotoet al. 2005, Blood 106: 2627-32; Ito et al. 2004, Gastroenterology 126:989-96; Choy et al. 2002, Arthritis Rheum. 46: 3143-50), BE8 (Batailleet al. 1995, Blood 86: 685-91; Emilie et al. 1994, Blood 84: 2472-9;Beck et al. 1994, N. Engl. J. Med. 330: 602-5; Wendling et al. 1993, J.Rheumatol. 20: 259-62) and CNTO-328 of Centocor (2004, Journal ofClinical Oncology 22/14S: 2560; 2004, Journal of Clinical Oncology22/14S: 2608; 2004, Int. J. Cancer 111: 592-5). Another active principleknown in the art for the prevention and treatment of IL-6 relateddisorders is an Fc fusion of soluble gp130 (Becker et al. 2004, Immunity21: 491-501; Doganci et al. 2005, J. Clin. Invest. 115: 313-25; Nowellet al. 2003, J. Immunol. 171: 3202-9; Atreya et al. 2000, Nat. Med. 6:583-8). Immunoglobulin single variable domains directed against IL-6Rand polypeptides comprising the same have been described in WO08/020079. Improved immunoglobulin single variable domains directedagainst IL-6R, have been described in WO 2010/115998 (see e.g. SEQ IDNOs: 60-72 of WO 2010/115998).

Tocilizumab is a humanized anti-human IL-6R antibody engineered bygrafting the complementarily determining regions of a mouse anti-humanIL-6R antibody into human IgG1κ to create a human antibody with a humanIL-6R binding site (Sato et al. 1993, Cancer Res. 53: 851-856).Tocilizumab binds to the IL-6 binding site of human IL-6R andcompetitively inhibits IL-6 signaling. A series of clinical studies haveshown that inhibition of IL-6 signaling by tocilizumab istherapeutically effective in RA, JIA, Castleman disease, and Crohn'sdisease (Nishimoto et al. 2003, J. Rheumatol. 30: 1426-1435; Nishimotoet al. 2004, Arthritis Rheum. 50: 1761-1769; Yokota et al. 2004,Autoimmun. Rev. 3: 599-600; Nishimote et al. 2005, Blood 106: 2627-2632;Ito et al. 2004, Gastroenterology 126: 989-996). In all of thesediseases, tocilizumab ameliorated inflammatory manifestations andnormalized acute phase protein levels, including C-reactive protein(CRP). Studies have confirmed 8 mg/kg every 4 weeks as the optimal doseand 4 mg/kg as the starting dose for the treatment of RA, with favorableefficacy and acceptable safety profiles. Tocilizumab 8 mg/kg every 4weeks produced a sustained, adequate blockade of IL-6 receptors andnormalized acute-phase reactants, such as C-reactive protein.

It was noticed that both serum IL-6 and serum sIL-6R increased inpatients when IL-6 signaling was inhibited by tocilizumab while thedisease symptoms continued to be ameliorated. Data showed that IL-6temporarily increased following administration of tocilizumab. Theincrease was most likely caused by IL-6R blockade inhibiting clearanceof IL-6 from the blood. Subsequently, there was a trend for decreasingIL-6 peak levels during 24 weeks for tocilizumab 8 mg/kg, suggestingdecreased IL-6 production with amelioration of the disease orinflammatory status.

Following multiple doses of tocilizumab 4 or 8 mg/kg every 4 weeks for24 weeks, mean sIL-6R levels increased with increasing treatmentduration and reached a plateau at approximately weeks 8-12. For the 4mg/kg dose, sIL-6R levels increased slightly with treatment duration.Peak sIL-6R levels were achieved in the middle of the dosing interval(i.e., at weeks 2, 6 and 14). The highest mean sIL-6R levels fortocilizumab 4 mg/kg were 5.1-5.6-fold above baseline. For the 8 mg/kgdose, mean sIL-6R levels remained high and increased with treatmentduration, with minor fluctuations within the dosing interval. Thehighest mean sIL-6R levels for tocilizumab 8 mg/kg were 10-14-fold abovebaseline. The sustained increase in sIL-6R levels observed for the 8mg/kg dose suggests persistent binding of tocilizumab to sIL-6R. At the4 mg/kg dose, the fluctuating levels of sIL-6R suggest that tocilizumabexposure was below that for consistent binding of tocilizumab to sIL-6R.The accumulation of the sIL-6R in serum with an increasing number oftocilizumab infusions suggests that the tocilizumab/sIL-6R complex has aslower clearance than sIL-6R (Levi et al. 2008, Ann. Rheum. Dis. 67(Suppl. II): 192).

Mean CRP normalized by week 2 of treatment with tocilizumab 8 mg/kgevery 4 weeks and remained below the upper limit of normal through toweek 24. By contrast, the improvement with tocilizumab 4 mg/kg was lessstriking and CRP concentrations fluctuated during the dosing interval(Smolen et al. 2008, Lancet 371: 987-997). Higher tocilizumab AUC (areaunder the curve for serum tocilizumab concentration-time profile fromweek 0-24) was associated with a more persistent low CRP level with anormal range from pooled pivotal Phase III studies (Levi et al. 2008,Ann. Rheum. Dis. 67 (Suppl. II): 192). Tocilizumab normalized the CRPlevels in patients with RA as long as free tocilizumab remained ≥μg/ml(Nishimoto et al. 2008, Blood 112: 3959-3964).

It was shown that, after tocilizumab administration, more than 95% ofthe sIL-6R molecules were bound as immune complex, as long as the freetocilizumab concentration remained ≥μg/ml (Nishimoto et al. 2008, Blood112: 3959-3964). The relationship of tocilizumab, sIL-6R and CRPfollowing single-dose tocilizumab administration (10 mg/kg) in RApatients is further illustrated in FIG. 1 (Schmitt et al. 2010, Clin.Pharmacol. Ther. 89: 735-740). (Zhan and Peck, 2011, Expert Rev. Clin.Pharmacol. 4: 539-558)

SUMMARY OF THE INVENTION

The present invention is based on the finding that the administration tohuman subjects of polypeptides as described herein that specificallybind IL-6R (also referred herein as “polypeptides of the invention”)provides an unexpectedly sustained, prolonged effect on IL-6 mediatedsignaling in the human subjects as observed through changes in relevantbiomarkers (such as sIL-6R, IL-6, CRP, ESR, fibrinogen and/or serumamyloid A). This sustained, prolonged effect on IL-6 mediated signalingis mainly caused by a slower target mediated clearance of thepolypeptide of the invention compared to the target mediated clearanceof tocilizumab, of which the value was used in preclinical modeling.Because of this slower target mediated clearance of the polypeptide ofthe invention an unexpectedly sustained, prolonged effect on IL-6mediated signaling in the human subjects was observed compared to whatwas assessed based on pre-clinical modeling. As a consequence, lesstherapeutic molecules (i.e. lower doses) need to be administered, orless frequent dosing of the therapeutic molecule needs to be applied inorder to obtained the same effect on IL-6 mediated signaling (observedthrough changes in relevant biomarkers such as sIL-6R, IL-6, CRP, ESR,fibrinogen and serum amyloid A). Alternatively, a longer effect on IL-6mediated signaling can be obtained with a similar dose of thepolypeptide of the invention.

Accordingly, the present invention provides methods for inhibiting IL-6mediated signaling in a subject by administering to the subject apolypeptide of the invention, wherein the amount of the polypeptideadministered is effective to change one or more markers of IL-6 mediatedsignaling, such as total sIL-6R, total IL-6, CRP, ESR, fibrinogen and/orserum amyloid A, for unexpectedly prolonged periods of time. The presentinvention provides specific dose ranges and dosing schedules for thepolypeptides of the invention that result in this prolonged effect onIL-6 mediated signaling. In particular, the invention providespharmacologically active agents, compositions, methods and/or dosingschedules that have certain advantages compared to the agents,compositions, methods and/or dosing schedules that are currently usedand/or known in the art, including the ability to dose less frequentlyor to administer lower doses to obtain equivalent effects in inhibitingIL-6 mediated signaling. These advantages will become clear from thefurther description below.

Accordingly, in one aspect, the invention relates to a method forinhibiting IL-6 mediated signaling in a subject, said method comprisingadministering to the subject a polypeptide that specifically binds IL-6R(also referred to herein as “polypeptide of the invention”), wherein theamount of the polypeptide administered is effective to increase totalsIL-6R levels in serum to at least 400 ng/ml and to maintain totalsIL-6R levels in serum at at least 400 ng/ml for at least 4 weeks afteradministration. The invention thus also relates to a polypeptide of theinvention for inhibiting IL-6 mediated signaling, wherein the amount ofthe polypeptide administered is effective to increase total sIL-6Rlevels in serum to at least 400 ng/ml and to maintain total sIL-6Rlevels in serum at at least 400 ng/ml for at least 4 weeks afteradministration. The invention also relates to a polypeptide of theinvention for treatment of diseases and/or disorders associated withIL-6 mediated signaling, wherein the amount of the polypeptideadministered is effective to increase total sIL-6R levels in serum to atleast 400 ng/ml and to maintain total sIL-6R levels in serum at at least400 ng/ml for at least 4 weeks after administration.

In another aspect, the invention relates to a method for inhibiting IL-6mediated signaling in a subject comprising administering to the subjecta polypeptide of the invention, wherein the amount of the polypeptideadministered is effective to increase total IL-6 levels in serum to atleast 40 pg/ml and to maintain total IL-6 levels in serum at at least 40pg/ml for at least 4 weeks after administration. The invention thus alsorelates to a polypeptide of the invention for inhibiting IL-6 mediatedsignaling, wherein the amount of the polypeptide administered iseffective to increase total IL-6 levels in serum to at least 40 pg/mland to maintain total IL-6 levels in serum at at least 40 pg/ml for atleast 4 weeks after administration. The invention also relates to apolypeptide of the invention for treatment of diseases and/or disordersassociated with IL-6 mediated signaling, wherein the amount of thepolypeptide administered is effective to increase total IL-6 levels inserum to at least 40 pg/ml and to maintain total IL-6 levels in serum atat least 40 pg/ml for at least 4 weeks after administration.

In a further aspect, the invention relates to a method for inhibitingIL-6 mediated signaling in a subject comprising administering to thesubject a polypeptide of the invention, wherein the amount of thepolypeptide administered is effective to reduce CRP levels in serumbelow 10 mg/l and to maintain CRP levels in serum below 10 mg/l for atleast 4 weeks after administration. The invention thus also relates to apolypeptide of the invention for inhibiting IL-6 mediated signaling,wherein the amount of the polypeptide administered is effective toreduce CRP levels in serum below 10 mg/l and to maintain CRP levels inserum below 10 mg/l for at least 4 weeks after administration. Theinvention also relates to a polypeptide of the invention for treatmentof diseases and/or disorders associated with IL-6 mediated signaling,wherein the amount of the polypeptide administered is effective toreduce CRP levels in serum below 10 mg/l and to maintain CRP levels inserum below 10 mg/l for at least 4 weeks after administration.

In a specific aspect, when the subject is also receiving methotrexate(MTX) therapy, the baseline CRP levels (i.e. the CRP levels beforedosing the polypeptide of the invention) in serum are most likelyalready below 10 mg/ml (unrelated to the anti-IL-6R therapy).Accordingly, “reduction of CRP levels in serum below 10 mg/l andmaintenance of CRP levels in serum below 10 mg/l” cannot be used as arelevant marker for the pharmacodynamic effect of the polypeptide of theinvention in subjects that also receive MTX therapy, but only insubjects that do not receive methotrexate (MTX) therapy.

Therefore, in certain cases (such as when the subject is also receivingMTX therapy), changes in CRP levels can also be determined as “%reduction compared to baseline (i.e. CRP levels before treatment withthe polypeptide of the invention (pre-treatment) and/or at normallevels)”. In a further aspect, the invention relates to a method forinhibiting IL-6 mediated signaling in a subject comprising administeringto the subject a polypeptide of the invention, wherein the amount of thepolypeptide administered is effective to reduce CRP levels in serum by50% or more compared to baseline (i.e. pre-treatment or normal) levelsand to maintain CRP levels in serum at 50% or more reduction compared tobaseline levels for at least 4 weeks after administration. The inventionthus also relates to a polypeptide of the invention for inhibiting IL-6mediated signaling, wherein the amount of the polypeptide administeredis effective to reduce CRP levels in serum by 50% or more compared tobaseline (i.e. pre-treatment or normal) levels and to maintain CRPlevels in serum at 50% or more reduction compared to baseline levels forat least 4 weeks after administration. The invention also relates to apolypeptide of the invention for treatment of diseases and/or disordersassociated with IL-6 mediated signaling, wherein the amount of thepolypeptide administered is effective to reduce CRP levels in serum by50% or more compared to baseline (i.e. pre-treatment or normal) levelsand to maintain CRP levels in serum at 50% or more reduction compared tobaseline levels for at least 4 weeks after administration.

In a further aspect, the invention relates to a method for inhibitingIL-6 mediated signaling in a subject comprising administering to thesubject a polypeptide of the invention, wherein the amount of thepolypeptide administered is effective to reduce ESR levels in serum by30% or more compared to baseline (i.e. pre-treatment or normal) levelsand to maintain ESR levels in serum at 30% or more reduction compared tobaseline levels for at least 4 weeks after administration. The inventionthus also relates to a polypeptide of the invention for inhibiting IL-6mediated signaling, wherein the amount of the polypeptide administeredis effective to reduce ESR levels in serum by 30% or more compared tobaseline (i.e. pre-treatment or normal) levels and to maintain ESRlevels in serum at 30% or more reduction compared to baseline levels forat least 4 weeks after administration. The invention also relates to apolypeptide of the invention for treatment of diseases and/or disordersassociated with IL-6 mediated signaling, wherein the amount of thepolypeptide administered is effective to reduce ESR levels in serum by30% or more compared to baseline (i.e. pre-treatment or normal) levelsand to maintain ESR levels in serum at 30% or more reduction compared tobaseline levels for at least 4 weeks after administration.

In a further aspect, the invention relates to a method for inhibitingIL-6 mediated signaling in a subject comprising administering to thesubject a polypeptide of the invention, wherein the amount of thepolypeptide administered is effective to reduce fibrinogen levels inserum by 30% or more compared to baseline (i.e. pre-treatment or normal)levels and to maintain fibrinogen levels in serum at 30% or morereduction compared to baseline levels for at least 4 weeks afteradministration. The invention thus also relates to a polypeptide of theinvention for inhibiting IL-6 mediated signaling, wherein the amount ofthe polypeptide administered is effective to reduce fibrinogen levels inserum by 30% or more compared to baseline (i.e. pre-treatment or normal)levels and to maintain fibrinogen levels in serum at 30% or morereduction compared to baseline levels for at least 4 weeks afteradministration. The invention also relates to a polypeptide of theinvention for treatment of diseases and/or disorders associated withIL-6 mediated signaling, wherein the amount of the polypeptideadministered is effective to reduce fibrinogen levels in serum by 30% ormore compared to baseline (i.e. pre-treatment or normal) levels and tomaintain fibrinogen levels in serum at 30% or more reduction compared tobaseline levels for at least 4 weeks after administration.

In a further aspect, the invention relates to a method for inhibitingIL-6 mediated signaling in a subject comprising administering to thesubject a polypeptide of the invention, wherein the amount of thepolypeptide administered is effective to reduce serum amyloid A levelsby 30% or more compared to baseline (i.e. pre-treatment or normal)levels and to maintain serum amyloid A levels at 30% or more reductioncompared to baseline levels for at least 4 weeks after administration.The invention thus also relates to a polypeptide of the invention forinhibiting IL-6 mediated signaling, wherein the amount of thepolypeptide administered is effective to reduce serum amyloid A levelsby 30% or more compared to baseline (i.e. pre-treatment or normal)levels and to maintain serum amyloid A levels at 30% or more reductioncompared to baseline levels for at least 4 weeks after administration.The invention also relates to a polypeptide of the invention fortreatment of diseases and/or disorders associated with IL-6 mediatedsignaling, wherein the amount of the polypeptide administered iseffective to reduce serum amyloid A levels by 30% or more compared tobaseline (i.e. pre-treatment or normal) levels and to maintain serumamyloid A levels at 30% or more reduction compared to baseline levelsfor at least 4 weeks after administration.

Preferably, total sIL-6R levels in serum are increased to at least 400ng/ml within two weeks after the start of the therapy (i.e. within twoweeks after administration of the polypeptide of the invention).

Preferably, total IL-6 levels in serum are increased to at least 40pg/ml within two weeks after the start of the therapy (i.e. within twoweeks after administration of the polypeptide of the invention).

Preferably, CRP levels in serum are reduced below 10 mg/l within twoweeks after the start of the therapy (i.e. within two weeks afteradministration of the polypeptide of the invention).

Preferably, CRP levels in serum are reduced by 50% or more compared tobaseline (i.e. pre-treatment or normal) levels within two weeks afterthe start of the therapy (i.e. within two weeks after administration ofthe polypeptide of the invention).

Preferably, ESR levels in serum are reduced by 30% or more compared tobaseline (i.e. pre-treatment or normal) levels within two weeks afterthe start of the therapy (i.e. within two weeks after administration ofthe polypeptide of the invention).

Preferably, fibrinogen levels in serum are reduced by 30% or morecompared to baseline (i.e. pre-treatment or normal) levels within twoweeks after the start of the therapy (i.e. within two weeks afteradministration of the polypeptide of the invention).

Preferably, serum amyloid A levels are reduced by 30% or more comparedto baseline (i.e. pre-treatment or normal) levels within two weeks afterthe start of the therapy (i.e. within two weeks after administration ofthe polypeptide of the invention).

In the method of the present invention, the polypeptide is administeredin an amount from about 1 mg/kg to about 10 mg/kg, preferably from about3 mg/kg to about 6 mg/kg. Accordingly, in a specific aspect, theinvention relates to a method for inhibiting IL-6 mediated signaling ina subject, said method comprising administering to the subject apolypeptide of the invention in an amount from about 1 mg/kg to about 10mg/kg, preferably from about 3 mg/kg to about 6 mg/kg, wherein totalsIL-6R levels in serum are increased to and maintained at at least 400ng/ml for at least 4 weeks after administration. The invention thus alsorelates to a polypeptide of the invention for inhibiting IL-6 mediatedsignaling, wherein the polypeptide is administered in an amount fromabout 1 mg/kg to about 10 mg/kg, preferably from about 3 mg/kg to about6 mg/kg and wherein total sIL-6R levels in serum are increased to andmaintained at at least 400 ng/ml for at least 4 weeks afteradministration. The invention also relates to a polypeptide of theinvention for treatment of diseases and/or disorders associated withIL-6 mediated signaling, wherein the polypeptide is administered in anamount from about 1 mg/kg to about 10 mg/kg, preferably from about 3mg/kg to about 6 mg/kg and wherein total sIL-6R levels in serum areincreased to and maintained at at least 400 ng/ml for at least 4 weeksafter administration.

In the method of the invention, the polypeptide of the invention isadministered in an amount from about 1 mg/kg to about 10 mg/kg,preferably from about 3 mg/kg to about 6 mg/kg and total sIL-6R levelsin serum are maintained at at least 400 ng/ml for up to 4 weeks or more,such as at least 5 weeks after administration, preferably at least 6weeks, or at least 7 weeks after administration, and most preferably atleast 8 weeks after administration.

In the method of the invention, the polypeptide of the invention isadministered in an amount from about 1 mg/kg to about 10 mg/kg,preferably from about 3 mg/kg to about 6 mg/kg and total sIL-6R levelsin serum are increased to and maintained at at least 400 ng/ml or more,such as at least 500 ng/ml, preferably at least 600 ng/ml, at least 650ng/ml, or even at least 700 ng/ml or more, for up to 4 weeks or more.

In another aspect, the invention relates to a method for inhibiting IL-6mediated signaling in a subject, said method comprising administering tothe subject a polypeptide of the invention in an amount from about 1mg/kg to about 10 mg/kg, preferably from about 3 mg/kg to about 6 mg/kg,wherein total IL-6 levels in serum are increased to and maintained at atleast 40 pg/ml for at least 4 weeks after administration. The inventionthus also relates to a polypeptide of the invention for inhibiting IL-6mediated signaling, wherein the polypeptide is administered in an amountfrom about 1 mg/kg to about 10 mg/kg, preferably from about 3 mg/kg toabout 6 mg/kg and wherein total IL-6 levels in serum are increased toand maintained at at least 40 pg/ml for at least 4 weeks afteradministration. The invention also relates to a polypeptide of theinvention for treatment of diseases and/or disorders associated withIL-6 mediated signaling, wherein the polypeptide is administered in anamount from about 1 mg/kg to about 10 mg/kg, preferably from about 3mg/kg to about 6 mg/kg and wherein total IL-6 levels in serum areincreased to and maintained at at least 40 pg/ml for at least 4 weeksafter administration.

In the method of the invention, the polypeptide of the invention isadministered in an amount from about 1 mg/kg to about 10 mg/kg,preferably from about 3 mg/kg to about 6 mg/kg and total IL-6 levels inserum are maintained at at least 40 pg/ml for up to 4 weeks or more,such as at least 5 weeks after administration, preferably at least 6weeks, or at least 7 weeks after administration, and most preferably atleast 8 weeks after administration.

In the method of the invention, the polypeptide of the invention isadministered in an amount from about 1 mg/kg to about 10 mg/kg,preferably from about 3 mg/kg to about 6 mg/kg and total IL-6 levels inserum are increased to and maintained at at least 40 pg/ml or more, suchas at least 50 pg/ml, preferably at least 60 pg/ml or more, for up to 4weeks or more.

In a further aspect, the invention relates to a method for inhibitingIL-6 mediated signaling in a subject, said method comprisingadministering to the subject a polypeptide of the invention in an amountfrom about 1 mg/kg to about 10 mg/kg, preferably from about 3 mg/kg toabout 6 mg/kg, wherein CRP levels in serum are decreased to andmaintained below 10 mg/l for at least 4 weeks after administration. Theinvention thus also relates to a polypeptide of the invention forinhibiting of IL-6 mediated signaling, wherein the polypeptide isadministered in an amount from about 1 mg/kg to about 10 mg/kg,preferably from about 3 mg/kg to about 6 mg/kg and wherein CRP levels inserum are decreased to and maintained below 10 mg/l for at least 4 weeksafter administration. The invention also relates to a polypeptide of theinvention for treatment of diseases and/or disorders associated withIL-6 mediated signaling, wherein the polypeptide is administered in anamount from about 1 mg/kg to about 10 mg/kg, preferably from about 3mg/kg to about 6 mg/kg and wherein CRP levels in serum are decreased toand maintained below 10 mg/l for at least 4 weeks after administration.

In the method of the invention, the polypeptide of the invention isadministered in an amount from about 1 mg/kg to about 10 mg/kg,preferably from about 3 mg/kg to about 6 mg/kg and CRP levels in serumare maintained below 10 mg/l for up to 4 weeks or more, such as at least5 weeks after administration, preferably at least 6 weeks, or at least 7weeks after administration, and most preferably at least 8 weeks afteradministration.

In the method of the invention, the polypeptide of the invention isadministered in an amount amount from about 1 mg/kg to about 10 mg/kg,preferably from about 3 mg/kg to about 6 mg/kg and CRP levels in serumare decreased to and maintained below 10 mg/l or less, such as below 9mg/l, below 8 mg/l, more preferably below 7.5 mg/l, below 7 mg/l, below6.5 mg/l, most preferably below 6 mg/l, below 5.5 mg/l or below 5 mg/lor lower, for up to 4 weeks or more.

In a specific aspect, when the subject is also receiving methotrexate(MTX) therapy, the baseline CRP levels (i.e. the CRP levels beforedosing the polypeptide of the invention) in serum are most likelyalready below 10 mg/ml (unrelated to the anti-IL-6R therapy).Accordingly, “reduction of CRP levels in serum below 10 mg/l andmaintenance of CRP levels in serum below 10 mg/l” cannot be used as arelevant marker for the pharmacodynamic effect of the polypeptide of theinvention in subjects that also receive MTX therapy, but only insubjects that do not receive methotrexate (MTX) therapy.

In a further aspect, the invention relates to a method for inhibitingIL-6 mediated signaling in a subject, said method comprisingadministering to the subject a polypeptide of the invention in an amountfrom about 1 mg/kg to about 10 mg/kg, preferably from about 3 mg/kg toabout 6 mg/kg, wherein CRP levels in serum are decreased by andmaintained at 50% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels for at least 4 weeks afteradministration. The invention thus also relates to a polypeptide of theinvention for inhibiting of IL-6 mediated signaling, wherein thepolypeptide is administered in an amount from about 1 mg/kg to about 10mg/kg, preferably from about 3 mg/kg to about 6 mg/kg and wherein CRPlevels in serum are decreased by and maintained at 50% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levelsfor at least 4 weeks after administration. The invention also relates toa polypeptide of the invention for treatment of diseases and/ordisorders associated with IL-6 mediated signaling, wherein thepolypeptide is administered in an amount from about 1 mg/kg to about 10mg/kg, preferably from about 3 mg/kg to about 6 mg/kg and wherein CRPlevels in serum are decreased by and maintained at 50% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levelsfor at least 4 weeks after administration.

In the method of the invention, the polypeptide of the invention isadministered in an amount from about 1 mg/kg to about 10 mg/kg,preferably from about 3 mg/kg to about 6 mg/kg and CRP levels in serumare maintained at 50% or more reduction compared to baseline (i.e.pre-treatment or normal) levels for up to 4 weeks or more, such as atleast 5 weeks after administration, preferably at least 6 weeks, or atleast 7 weeks after administration, and most preferably at least 8 weeksafter administration.

In the method of the invention, the polypeptide of the invention isadministered in an amount from about 1 mg/kg to about 10 mg/kg,preferably from about 3 mg/kg to about 6 mg/kg and CRP levels in serumare decreased by and maintained at 50% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels, at 30% or more, 40% ormore, 50% or more, 60% or more, or even 70% or more reduction comparedto baseline (i.e. pre-treatment or normal) levels, for up to 4 weeks ormore.

In a further aspect, the invention relates to a method for inhibitingIL-6 mediated signaling in a subject, said method comprisingadministering to the subject a polypeptide of the invention in an amountfrom about 1 mg/kg to about 10 mg/kg, preferably from about 3 mg/kg toabout 6 mg/kg, wherein ESR levels in serum are decreased by andmaintained at 30% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels for at least 4 weeks afteradministration. The invention thus also relates to a polypeptide of theinvention for inhibiting of IL-6 mediated signaling, wherein thepolypeptide is administered in an amount from about 1 mg/kg to about 10mg/kg, preferably from about 3 mg/kg to about 6 mg/kg and wherein ESRlevels in serum are decreased by and maintained at 30% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levelsfor at least 4 weeks after administration. The invention also relates toa polypeptide of the invention for treatment of diseases and/ordisorders associated with IL-6 mediated signaling, wherein thepolypeptide is administered in an amount from about 1 mg/kg to about 10mg/kg, preferably from about 3 mg/kg to about 6 mg/kg and wherein ESRlevels in serum are decreased by and maintained at 30% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levelsfor at least 4 weeks after administration.

In the method of the invention, the polypeptide of the invention isadministered in an amount from about 1 mg/kg to about 10 mg/kg,preferably from about 3 mg/kg to about 6 mg/kg and ESR levels in serumare maintained at 30% or more reduction compared to baseline (i.e.pre-treatment or normal) levels for up to 4 weeks or more, such as atleast 5 weeks after administration, preferably at least 6 weeks, or atleast 7 weeks after administration, and most preferably at least 8 weeksafter administration.

In the method of the invention, the polypeptide of the invention isadministered in an amount from about 1 mg/kg to about 10 mg/kg,preferably from about 3 mg/kg to about 6 mg/kg and ESR levels in serumare decreased by and maintained at 30% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels, such as at 40% or more,50% or more, 60% or more, or even 70% or more reduction compared tobaseline (i.e. pre-treatment or normal) levels, for up to 4 weeks ormore.

In a further aspect, the invention relates to a method for inhibitingIL-6 mediated signaling in a subject, said method comprisingadministering to the subject a polypeptide of the invention in an amountfrom about 1 mg/kg to about 10 mg/kg, preferably from about 3 mg/kg toabout 6 mg/kg, wherein fibrinogen levels in serum are decreased by andmaintained at 30% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels for at least 4 weeks afteradministration. The invention thus also relates to a polypeptide of theinvention for inhibiting of IL-6 mediated signaling, wherein thepolypeptide is administered in an amount from about 1 mg/kg to about 10mg/kg, preferably from about 3 mg/kg to about 6 mg/kg and whereinfibrinogen levels in serum are decreased by and maintained at 30% ormore (reduction) compared to baseline (i.e. pre-treatment or normal)levels for at least 4 weeks after administration. The invention alsorelates to a polypeptide of the invention for treatment of diseasesand/or disorders associated with IL-6 mediated signaling, wherein thepolypeptide is administered in an amount from about 1 mg/kg to about 10mg/kg, preferably from about 3 mg/kg to about 6 mg/kg and whereinfibrinogen levels in serum are decreased by and maintained at 30% ormore (reduction) compared to baseline (i.e. pre-treatment or normal)levels for at least 4 weeks after administration.

In the method of the invention, the polypeptide of the invention isadministered in an amount from about 1 mg/kg to about 10 mg/kg,preferably from about 3 mg/kg to about 6 mg/kg and fibrinogen levels inserum are maintained at 30% or more reduction compared to baseline (i.e.pre-treatment or normal) levels for up to 4 weeks or more, such as atleast 5 weeks after administration, preferably at least 6 weeks, or atleast 7 weeks after administration, and most preferably at least 8 weeksafter administration.

In the method of the invention, the polypeptide of the invention isadministered in an amount from about 1 mg/kg to about 10 mg/kg,preferably from about 3 mg/kg to about 6 mg/kg and fibrinogen levels inserum are decreased by and maintained at 30% or more (reduction)compared to baseline (i.e. pre-treatment or normal) levels, at 20% ormore, 30% or more, 40% or more, or even 50% or more reduction comparedto baseline (i.e. pre-treatment or normal) levels, for up to 4 weeks ormore.

In a further aspect, the invention relates to a method for inhibitingIL-6 mediated signaling in a subject, said method comprisingadministering to the subject a polypeptide of the invention in an amountfrom about 1 mg/kg to about 10 mg/kg, preferably from about 3 mg/kg toabout 6 mg/kg, wherein serum amyloid A levels are decreased by andmaintained at 30% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels for at least 4 weeks afteradministration. The invention thus also relates to a polypeptide of theinvention for inhibiting of IL-6 mediated signaling, wherein thepolypeptide is administered in an amount from about 1 mg/kg to about 10mg/kg, preferably from about 3 mg/kg to about 6 mg/kg and wherein serumamyloid A levels are decreased by and maintained at 30% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levelsfor at least 4 weeks after administration. The invention also relates toa polypeptide of the invention for treatment of diseases and/ordisorders associated with IL-6 mediated signaling, wherein thepolypeptide is administered in an amount from about 1 mg/kg to about 10mg/kg, preferably from about 3 mg/kg to about 6 mg/kg and wherein serumamyloid A levels are decreased by and maintained at 30% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levelsfor at least 4 weeks after administration.

In the method of the invention, the polypeptide of the invention isadministered in an amount from about 1 mg/kg to about 10 mg/kg,preferably from about 3 mg/kg to about 6 mg/kg and serum amyloid Alevels are maintained at 30% or more reduction compared to baseline(i.e. pre-treatment or normal) levels for up to 4 weeks or more, such asat least 5 weeks after administration, preferably at least 6 weeks, orat least 7 weeks after administration, and most preferably at least 8weeks after administration.

In the method of the invention, the polypeptide of the invention isadministered in an amount from about 1 mg/kg to about 10 mg/kg,preferably from about 3 mg/kg to about 6 mg/kg and serum amyloid Alevels are decreased by and maintained at 30% or more (reduction)compared to baseline (i.e. pre-treatment or normal) levels, such as at40% or more, 50% or more, 60% or more, or even 70% or more reductioncompared to baseline (i.e. pre-treatment or normal) levels, for up to 4weeks or more.

In one aspect, the polypeptide of the invention is administered as asingle dose. In another aspect, the polypeptide of the invention isadministered as a multiple dose. Preferred frequencies of administeringthe polypeptide of the invention include 4 to 8 weekly dosing, such as 4weekly or 8 weekly dosing. Preferred dosage schedules include about 3mg/kg every 4 weeks, about 6 mg/kg every 4 weeks, and about 6 mg/kgevery 8 weeks.

The invention thus relates to a method for inhibiting IL-6 mediatedsignaling in a subject, said method comprising administering to thesubject a polypeptide of the invention in an amount from about 3 mg/kgto about 6 mg/kg every 4 to 8 weeks (such as e.g. 3 mg/kg every 4 weeks,6 mg/kg every 4 weeks, or 6 mg/kg every 8 weeks), wherein total sIL-6Rlevels in serum are increased to and maintained (throughout thetreatment period) at at least 400 ng/ml. The invention thus also relatesto a polypeptide of the invention for inhibiting IL-6 mediatedsignaling, wherein the polypeptide is administered in an amount fromabout 3 mg/kg to about 6 mg/kg every 4 to 8 weeks (such as e.g. 3 mg/kgevery 4 weeks, 6 mg/kg every 4 weeks, or 6 mg/kg every 8 weeks) andwherein total sIL-6R levels in serum are increased to and maintained(throughout the treatment period) at at least 400 ng/ml. The inventionalso relates to a polypeptide of the invention for treatment of diseasesand/or disorders associated with IL-6 mediated signaling, wherein thepolypeptide is administered in an amount from about 3 mg/kg to about 6mg/kg every 4 to 8 weeks (such as e.g. 3 mg/kg every 4 weeks, 6 mg/kgevery 4 weeks, or 6 mg/kg every 8 weeks) and wherein total sIL-6R levelsin serum are increased to and maintained (throughout the treatmentperiod) at at least 400 ng/ml.

In the method of the invention, the polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 6 mg/kg every 4 to8 weeks (such as e.g. 3 mg/kg every 4 weeks, 6 mg/kg every 4 weeks, or 6mg/kg every 8 weeks) and total sIL-6R levels in serum are increased toand maintained at at least 400 ng/ml or more, such as at least 500ng/ml, preferably at least 600 ng/ml, at least 650 ng/ml, or even atleast 700 ng/ml or more.

In another aspect, the invention relates to a method for inhibiting IL-6mediated signaling in a subject, said method comprising administering tothe subject a polypeptide of the invention in an amount from about 3mg/kg to about 6 mg/kg every 4 to 8 weeks (such as e.g. 3 mg/kg every 4weeks, 6 mg/kg every 4 weeks, or 6 mg/kg every 8 weeks), wherein totalIL-6 levels in serum are increased to and maintained at at least 40pg/ml. The invention thus also relates to a polypeptide of the inventionfor inhibiting IL-6 mediated signaling, wherein the polypeptide isadministered in an amount from about 3 mg/kg to about 6 mg/kg every 4 to8 weeks (such as e.g. 3 mg/kg every 4 weeks, 6 mg/kg every 4 weeks, or 6mg/kg every 8 weeks) and wherein total IL-6 levels in serum areincreased to and maintained at at least 40 pg/ml. The invention alsorelates to a polypeptide of the invention for treatment of diseasesand/or disorders associated with IL-6 mediated signaling, wherein thepolypeptide is administered in an amount from about 3 mg/kg to about 6mg/kg every 4 to 8 weeks (such as e.g. 3 mg/kg every 4 weeks, 6 mg/kgevery 4 weeks, or 6 mg/kg every 8 weeks) and wherein total IL-6 levelsin serum are increased to and maintained at at least 40 pg/ml.

In the method of the invention, the polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 6 mg/kg every 4 to8 weeks (such as 3 mg/kg every 4 weeks, 6 mg/kg every 4 week,s or 6mg/kg every 8 weeks) and total IL-6 levels in serum are increased to andmaintained at at least 40 pg/ml or more, such as at least 50 pg/ml,preferably at least 60 pg/ml or more.

In a further aspect, the invention relates to a method for inhibitingIL-6 mediated signaling in a subject, said method comprisingadministering to the subject a polypeptide of the invention in an amountfrom about 3 mg/kg to about 6 mg/kg every 4 to 8 weeks (such as e.g. 3mg/kg every 4 weeks, 6 mg/kg every 4 weeks, or 6 mg/kg every 8 weeks),wherein CRP levels in serum are decreased to and maintained below 10mg/l. The invention thus also relates to a polypeptide of the inventionfor inhibiting IL-6 mediated signaling, wherein the polypeptide isadministered in an amount from about 3 mg/kg to about 6 mg/kg every 4 to8 weeks (such as e.g. 3 mg/kg every 4 weeks, 6 mg/kg every 4 weeks, or 6mg/kg every 8 weeks) and wherein CRP levels in serum are decreased toand maintained below 10 mg/l. The invention also relates to apolypeptide of the invention for treatment of diseases and/or disordersassociated with IL-6 mediated signaling, wherein the polypeptide isadministered in an amount from about 3 mg/kg to about 6 mg/kg every 4 to8 weeks (such as e.g. 3 mg/kg every 4 weeks, 6 mg/kg every 4 weeks, or 6mg/kg every 8 weeks) and wherein CRP levels in serum are decreased toand maintained below 10 mg/l.

In the method of the invention, the polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 6 mg/kg every 4 to8 weeks (such as e.g. 3 mg/kg every 4 weeks, 6 mg/kg every 4 weeks, or 6mg/kg every 8 weeks) and CRP levels in serum are decreased to andmaintained below 10 mg/l or less, such as below 9 mg/l, below 8 mg/l,more preferably below 7.5 mg/l, below 7 mg/l, below 6.5 mg/l, mostpreferably below 6 mg/l, below 5.5 mg/l or below 5 mg/l or lower.

In a specific aspect, when the subject is also receiving methotrexate(MTX) therapy, the baseline CRP levels (i.e. the CRP levels beforedosing the polypeptide of the invention) in serum are most likelyalready below 10 mg/ml or less (unrelated to the anti-IL-6R therapy).Accordingly, “reduction of CRP levels in serum below 10 mg/l or less andmaintenance of CRP levels in serum below 10 mg/l or less” cannot be usedas a relevant marker for the pharmacodynamic effect of the polypeptideof the invention in subjects that also receive MTX therapy, but only insubjects that do not receive methotrexate (MTX) therapy.

In a further aspect, the invention relates to a method for inhibitingIL-6 mediated signaling in a subject, said method comprisingadministering to the subject a polypeptide of the invention in an amountfrom about 3 mg/kg to about 6 mg/kg every 4 to 8 weeks (such as e.g. 3mg/kg every 4 weeks, 6 mg/kg every 4 weeks, or 6 mg/kg every 8 weeks),wherein CRP levels in serum are decreased by and maintained at 50% ormore (reduction) compared to baseline (i.e. pre-treatment or normal)levels. The invention thus also relates to a polypeptide of theinvention for inhibiting IL-6 mediated signaling, wherein thepolypeptide is administered in an amount from about 3 mg/kg to about 6mg/kg every 4 to 8 weeks (such as e.g. 3 mg/kg every 4 weeks, 6 mg/kgevery 4 weeks, or 6 mg/kg every 8 weeks) and wherein CRP levels in serumare decreased by and maintained at 50% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels. The invention alsorelates to a polypeptide of the invention for treatment of diseasesand/or disorders associated with IL-6 mediated signaling, wherein thepolypeptide is administered in an amount from about 3 mg/kg to about 6mg/kg every 4 to 8 weeks (such as e.g. 3 mg/kg every 4 weeks, 6 mg/kgevery 4 weeks, or 6 mg/kg every 8 weeks) and wherein CRP levels in serumare decreased by and maintained at 50% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels.

In the method of the invention, the polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 6 mg/kg every 4 to8 weeks (such as e.g. 3 mg/kg every 4 weeks, 6 mg/kg every 4 weeks, or 6mg/kg every 8 weeks) and CRP levels in serum are decreased by andmaintained at 50% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels, at 30% or more, 40% or more, 50% ormore, 60% or more, or even 70% or more reduction compared to baseline(i.e. pre-treatment or normal) levels.

In a further aspect, the invention relates to a method for inhibitingIL-6 mediated signaling in a subject, said method comprisingadministering to the subject a polypeptide of the invention in an amountfrom about 3 mg/kg to about 6 mg/kg every 4 to 8 weeks (such as e.g. 3mg/kg every 4 weeks, 6 mg/kg every 4 weeks, or 6 mg/kg every 8 weeks),wherein ESR levels in serum are decreased by and maintained at 30% ormore (reduction) compared to baseline (i.e. pre-treatment or normal)levels. The invention thus also relates to a polypeptide of theinvention for inhibiting IL-6 mediated signaling, wherein thepolypeptide is administered in an amount from about 3 mg/kg to about 6mg/kg every 4 to 8 weeks (such as e.g. 3 mg/kg every 4 weeks, 6 mg/kgevery 4 weeks, or 6 mg/kg every 8 weeks) and wherein ESR levels in serumare decreased by and maintained at 30% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels. The invention alsorelates to a polypeptide of the invention for treatment of diseasesand/or disorders associated with IL-6 mediated signaling, wherein thepolypeptide is administered in an amount from about 3 mg/kg to about 6mg/kg every 4 to 8 weeks (such as e.g. 3 mg/kg every 4 weeks, 6 mg/kgevery 4 weeks, or 6 mg/kg every 8 weeks) and wherein ESR levels in serumare decreased by and maintained at 30% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels.

In the method of the invention, the polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 6 mg/kg every 4 to8 weeks (such as e.g. 3 mg/kg every 4 weeks, 6 mg/kg every 4 weeks, or 6mg/kg every 8 weeks) and ESR levels in serum are decreased by andmaintained at 30% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels, such as at 40% or more, 50% or more,60% or more, or even 70% or more reduction compared to baseline (i.e.pre-treatment or normal) levels.

In a further aspect, the invention relates to a method for inhibitingIL-6 mediated signaling in a subject, said method comprisingadministering to the subject a polypeptide of the invention in an amountfrom about 3 mg/kg to about 6 mg/kg every 4 to 8 weeks (such as e.g. 3mg/kg every 4 weeks, 6 mg/kg every 4 weeks, or 6 mg/kg every 8 weeks),wherein fibrinogen levels in serum are decreased by and maintained at30% or more (reduction) compared to baseline (i.e. pre-treatment ornormal) levels. The invention thus also relates to a polypeptide of theinvention for inhibiting IL-6 mediated signaling, wherein thepolypeptide is administered in an amount from about 3 mg/kg to about 6mg/kg every 4 to 8 weeks (such as e.g. 3 mg/kg every 4 weeks, 6 mg/kgevery 4 weeks, or 6 mg/kg every 8 weeks) and wherein fibrinogen levelsin serum are decreased by and maintained at 30% or more (reduction)compared to baseline (i.e. pre-treatment or normal) levels. Theinvention also relates to a polypeptide of the invention for treatmentof diseases and/or disorders associated with IL-6 mediated signaling,wherein the polypeptide is administered in an amount from about 3 mg/kgto about 6 mg/kg every 4 to 8 weeks (such as e.g. 3 mg/kg every 4 weeks,6 mg/kg every 4 weeks, or 6 mg/kg every 8 weeks) and wherein fibrinogenlevels in serum are decreased by and maintained at 30% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levels.

In the method of the invention, the polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 6 mg/kg every 4 to8 weeks (such as e.g. 3 mg/kg every 4 weeks, 6 mg/kg every 4 weeks, or 6mg/kg every 8 weeks) and fibrinogen levels in serum are decreased by andmaintained at 30% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels, at 20% or more, 30% or more, 40% ormore, or even 50% or more reduction compared to baseline (i.e.pre-treatment or normal) levels.

In a further aspect, the invention relates to a method for inhibitingIL-6 mediated signaling in a subject, said method comprisingadministering to the subject a polypeptide of the invention in an amountfrom about 3 mg/kg to about 6 mg/kg every 4 to 8 weeks (such as e.g. 3mg/kg every 4 weeks, 6 mg/kg every 4 weeks, or 6 mg/kg every 8 weeks),wherein serum amyloid A levels are decreased by and maintained at 30% ormore (reduction) compared to baseline (i.e. pre-treatment or normal)levels. The invention thus also relates to a polypeptide of theinvention for inhibiting IL-6 mediated signaling, wherein thepolypeptide is administered in an amount from about 3 mg/kg to about 6mg/kg every 4 to 8 weeks (such as e.g. 3 mg/kg every 4 weeks, 6 mg/kgevery 4 weeks, or 6 mg/kg every 8 weeks) and wherein serum amyloid Alevels are decreased by and maintained at 30% or more (reduction)compared to baseline (i.e. pre-treatment or normal) levels. Theinvention also relates to a polypeptide of the invention for treatmentof diseases and/or disorders associated with IL-6 mediated signaling,wherein the polypeptide is administered in an amount from about 3 mg/kgto about 6 mg/kg every 4 to 8 weeks (such as e.g. 3 mg/kg every 4 weeks,6 mg/kg every 4 weeks, or 6 mg/kg every 8 weeks) and wherein serumamyloid A levels are decreased by and maintained at 30% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levels.

In the method of the invention, the polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 6 mg/kg every 4 to8 weeks (such as e.g. 3 mg/kg every 4 weeks, 6 mg/kg every 4 weeks, or 6mg/kg every 8 weeks) and serum amyloid A levels are decreased by andmaintained at 30% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels, such as at 40% or more, 50% or more,60% or more, or even 70% or more reduction compared to baseline (i.e.pre-treatment or normal) levels.

The method of the present invention can be used for prevention and/ortreatment of subjects that suffer from IL-6 mediated diseases and/ordisorders, or diseases and/or disorders in which IL-6 mediated processescould play a role, i.e. diseases and/or disorders related to IL-6mediated signaling, such as but not limited to sepsis, various forms ofcancer (such as multiple myeloma disease (MM), renal cell carcinoma(RCC), plasma cell leukaemia, lymphoma, B-lymphoproliferative disorder(BLPD) and prostate cancer), bone resorption (osteoporosis), cachexia,psoriasis, mesangial proliferative glomerulonephritis, Kaposi's sarcoma,AIDS-related lymphoma, inflammatory diseases and disorder (such asrheumatoid arthritis, systemic onset juvenile idiopathic arthritis,hypergammaglobulinemia, Crohn's disease, ulcerative colitis, systemiclupus erythematosus (SLE), multiple sclerosis, Castleman's disease, IgMgammopathy, cardiac myxoma, asthma (in particular allergic asthma) andautoimmune insulin-dependent diabetes mellitus).

The polypeptide of the invention comprises or essentially consists ofone or more immunoglobulin single variable domains that specificallybind IL-6R. The one or more immunoglobulin single variable domains canbe light chain variable domain sequences (e.g. a VL-sequence), or heavychain variable domain sequences (e.g. a VH-sequence); more specifically,the immunoglobulin single variable domains can be heavy chain variabledomain sequences that are derived from a conventional four-chainantibody or heavy chain variable domain sequences that are derived froma heavy chain antibody. For example, the immunoglobulin single variabledomain may be a (single) domain, a “dAb” or dAb or a Nanobody (asdefined herein, and including but not limited to a VHH sequence).

Preferred polypeptides of the invention comprise or essentially consistof one or more immunoglobulin single variable domains that comprise oressentially consists of 4 framework regions (FR1 to FR4, respectively)and 3 complementarity determining regions (CDR1 to CDR3, respectively),in which (Table A-1):

-   -   a) CDR1 is chosen from the group consisting of: SEQ ID NO's:        17-19;    -   b) CDR2 is chosen from the group consisting of: SEQ ID NO's:        21-28; and    -   c) CDR3 is chosen from the group consisting of: SEQ ID NO's:        30-32.

Particularly preferred are polypeptides that comprise or essentiallyconsist of one or more immunoglobulin single variable domains that havea CDR1 with SEQ ID NO: 17, a CDR2 with SEQ ID NO: 21 and a CDR3 with SEQID NO: 30.

In another preferred aspect, the one or more immunoglobulin singlevariable domain present in the polypeptide of the invention is selectedfrom SEQ ID NOs: 1-10 (Table A-2), preferably SEQ ID NO: 1.

In another preferred aspect, the polypeptide of the invention maycomprise an half-life extension moiety. In one aspect, the half-lifeextension moiety specifically binds a serum protein, preferably serumalbumin, and in particular human serum albumin, thyroxine-bindingprotein, (human) transferrin, fibrinogen, an immunoglobulin such as IgG,IgE or IgM, or one of the serum proteins listed in WO 04/003019.

The half-life extension moiety may comprise or consist of animmunoglobulin single variable domain, such as e.g. a VHH domain, anhumanized VHH domain, a camelized VH domain, a domain antibody, a singledomain antibody and/or a “dAb”. Preferred immunoglobulin single variabledomains that bind serum albumin include SEQ ID NOs: 37-39 (Table A-4).

In a preferred aspect, the polypeptide of the invention is selected fromSEQ ID NOs: 34-36, preferably SEQ ID NO: 34. Accordingly, the inventionrelates to a method for inhibiting IL-6 mediated signaling in a subject,said method comprising administering to the subject a polypeptide withSEQ ID NO: 34 in an amount from about 3 mg/kg to about 6 mg/kg every 4to 8 weeks (such as e.g. 3 mg/kg every 4 weeks, 6 mg/kg every 4 weeks,or 6 mg/kg every 8 weeks), wherein total sIL-6R levels in serum areincreased to and maintained (throughout the treatment period) at atleast 400 ng/ml. The invention thus also relates to a polypeptide withSEQ ID NO: 34 for inhibiting IL-6 mediated signaling, wherein thepolypeptide is administered in an amount from about 3 mg/kg to about 6mg/kg every 4 to 8 weeks (such as e.g. 3 mg/kg every 4 weeks, 6 mg/kgevery 4 weeks, or 6 mg/kg every 8 weeks) and wherein total sIL-6R levelsin serum are increased to and maintained (throughout the treatmentperiod) at at least 400 ng/ml. The invention also relates to apolypeptide with SEQ ID NO: 34 for treatment of diseases and/ordisorders associated with IL-6 mediated signaling, wherein thepolypeptide is administered in an amount from about 3 mg/kg to about 6mg/kg every 4 to 8 weeks (such as e.g. 3 mg/kg every 4 weeks, 6 mg/kgevery 4 weeks, or 6 mg/kg every 8 weeks) and wherein total sIL-6R levelsin serum are increased to and maintained (throughout the treatmentperiod) at at least 400 ng/ml.

In one aspect of the invention, the polypeptide with SEQ ID NO: 34 isadministered in an amount from about 3 mg/kg to about 6 mg/kg every 4 to8 weeks (such as e.g. 3 mg/kg every 4 weeks, 6 mg/kg every 4 weeks, or 6mg/kg every 8 weeks) and total sIL-6R levels in serum are increased toand maintained at at least 400 ng/ml or more, such as at least 500ng/ml, preferably at least 600 ng/ml, at least 650 ng/ml, or even atleast 700 ng/ml or more.

In one aspect of the invention, the polypeptide with SEQ ID NO: 34 isadministered in an amount from about 3 mg/kg to about 6 mg/kg (such as 3mg/kg or 6 mg/kg) and total sIL-6R levels in serum are maintained at atleast 400 ng/ml for up to 4 weeks or more, such as at least 5 weeksafter administration, preferably at least 6 weeks or at least 7 weeksafter administration, and most preferably at least 8 weeks afteradministration.

In one aspect of the invention, the polypeptide with SEQ ID NO: 34 isadministered in an amount from about 3 mg/kg to about 6 mg/kg (such as 3mg/kg or 6 mg/kg) and total sIL-6R levels in serum are increased to andmaintained at at least 400 ng/ml or more, such as at least 500 ng/ml,preferably at least 600 ng/ml, at least 650 ng/ml, or even at least 700ng/ml or more, for up to at least 4 weeks or more.

In another aspect, the invention relates to a method for inhibiting IL-6mediated signaling in a subject, said method comprising administering tothe subject a polypeptide with SEQ ID NO: 34 in an amount from about 3mg/kg to about 6 mg/kg every 4 to 8 weeks (such as e.g. 3 mg/kg every 4weeks, 6 mg/kg every 4 weeks, or 6 mg/kg every 8 weeks), wherein totalIL-6 levels in serum are increased to and maintained at at least 40pg/ml. The invention thus also relates to a polypeptide with SEQ ID NO:34 for inhibiting IL-6 mediated signaling, wherein the polypeptide isadministered in an amount from about 3 mg/kg to about 6 mg/kg every 4 to8 weeks (such as e.g. 3 mg/kg every 4 weeks, 6 mg/kg every 4 weeks, or 6mg/kg every 8 weeks) and wherein total IL-6 levels in serum areincreased to and maintained at at least 40 pg/ml. The invention alsorelates to a polypeptide with SEQ ID NO: 34 for treatment of diseasesand/or disorders associated with IL-6 mediated signaling, wherein thepolypeptide is administered in an amount from about 3 mg/kg to about 6mg/kg every 4 to 8 weeks (such as e.g. 3 mg/kg every 4 weeks, 6 mg/kgevery 4 weeks, or 6 mg/kg every 8 weeks) and wherein total IL-6 levelsin serum are increased to and maintained at at least 40 pg/ml.

In the method of the invention, the polypeptide with SEQ ID NO: 34 isadministered in an amount from about 3 mg/kg to about 6 mg/kg every 4 to8 weeks (such as e.g. 3 mg/kg every 4 weeks, 6 mg/kg every 4 weeks, or 6mg/kg every 8 weeks) and total IL-6 levels in serum are increased to andmaintained at at least 40 pg/ml or more, such as at least 50 pg/ml,preferably at least 60 pg/ml or more.

In one aspect of the invention, the polypeptide with SEQ ID NO: 34 isadministered in an amount from about 3 mg/kg to about 6 mg/kg (such as 3mg/kg or 6 mg/kg) and total IL-6 levels in serum are maintained at atleast 40 pg/ml for up to 4 weeks or more, such as at least 5 weeks afteradministration, preferably at least 6 weeks or at least 7 weeks afteradministration, and most preferably at least 8 weeks afteradministration.

In the method of the invention, the polypeptide with SEQ ID NO: 34 isadministered in an amount from about 3 mg/kg to about 6 mg/kg (such as 3mg/kg or 6 mg/kg) and total IL-6 levels in serum are increased to andmaintained at at least 40 pg/ml or more, such as at least 50 pg/ml,preferably at least 60 pg/ml or pore, for up to at least 4 weeks ormore.

In a further aspect, the invention relates to a method for inhibitingIL-6 mediated signaling in a subject, said method comprisingadministering to the subject a polypeptide with SEQ ID NO: 34 in anamount from about 3 mg/kg to about 6 mg/kg every 4 to 8 weeks (such ase.g. 3 mg/kg every 4 weeks, 6 mg/kg every 4 weeks, or 6 mg/kg every 8weeks), wherein CRP levels in serum are decreased to and maintainedbelow 10 mg/l. The invention thus also relates to a polypeptide with SEQID NO: 34 for inhibiting IL-6 mediated signaling, wherein thepolypeptide is administered in an amount from about 3 mg/kg to about 6mg/kg every 4 to 8 weeks (such as e.g. 3 mg/kg every 4 weeks, 6 mg/kgevery 4 weeks, or 6 mg/kg every 8 weeks) and wherein CRP levels in serumare decreased to and maintained below 10 mg/l. The invention alsorelates to a polypeptide with SEQ ID NO: 34 for treatment of diseasesand/or disorders associated with IL-6 mediated signaling, wherein thepolypeptide is administered in an amount from about 3 mg/kg to about 6mg/kg every 4 to 8 weeks (such as e.g. 3 mg/kg every 4 weeks, 6 mg/kgevery 4 weeks, or 6 mg/kg every 8 weeks) and wherein CRP levels in serumare decreased to and maintained below 10 mg/l.

In the method of the invention, the polypeptide with SEQ ID NO: 34 isadministered in an amount from about 3 mg/kg to about 6 mg/kg every 4 to8 weeks (such as e.g. 3 mg/kg every 4 weeks, 6 mg/kg every 4 weeks, or 6mg/kg every 8 weeks) and CRP levels in serum are decreased to andmaintained below 10 mg/l or less, such as below 9 mg/l, below 8 mg/l,more preferably below 7.5 mg/l, below 7 mg/l, below 6.5 mg/l, mostpreferably below 6 mg/l, below 5.5 mg/l or below 5 mg/l or lower.

In one aspect of the invention, the polypeptide with SEQ ID NO: 34 isadministered in an amount from about 3 mg/kg to about 6 mg/kg (such as 3mg/kg or 6 mg/kg) and CRP levels in serum are maintained below 10 mg/lfor up to at least 4 weeks or more, such as at least 5 weeks afteradministration, preferably at least 6 weeks or at least 7 weeks afteradministration, and most preferably at least 8 weeks afteradministration.

In the method of the invention, the polypeptide with SEQ ID NO: 34 isadministered in an amount from about 3 mg/kg to about 6 mg/kg (such as 3mg/kg or 6 mg/kg) and CRP levels in serum are decreased to andmaintained below 10 mg/l or less, such as below 9 mg/l, below 8 mg/l,more preferably below 7.5 mg/l, below 7 mg/l, below 6.5 mg/l, mostpreferably below 6 mg/l, below 5.5 mg/l or below 5 mg/l or lower, for upto at least 4 weeks or more.

In a specific aspect, when the subject is also receiving methotrexate(MTX) therapy, the baseline CRP levels (i.e. the CRP levels beforedosing the polypeptide of the invention) in serum are most likelyalready below 10 mg/ml or less (unrelated to the anti-IL-6R therapy).Accordingly, “reduction of CRP levels in serum below 10 mg/l or less andmaintenance of CRP levels in serum below 10 mg/l or less” cannot be usedas a relevant marker for the pharmacodynamic effect of the polypeptidewith SEQ ID NO: 34 in subjects that also receive MTX therapy, but onlyin subjects that do not receive methotrexate (MTX) therapy.

In a further aspect, the invention relates to a method for inhibitingIL-6 mediated signaling in a subject, said method comprisingadministering to the subject a polypeptide with SEQ ID NO: 34 in anamount from about 3 mg/kg to about 6 mg/kg every 4 to 8 weeks (such ase.g. 3 mg/kg every 4 weeks, 6 mg/kg every 4 weeks, or 6 mg/kg every 8weeks), wherein CRP levels in serum are decreased by and maintained at50% or more (reduction) compared to baseline (i.e. pre-treatment ornormal) levels. The invention thus also relates to a polypeptide withSEQ ID NO: 34 for inhibiting IL-6 mediated signaling, wherein thepolypeptide is administered in an amount from about 3 mg/kg to about 6mg/kg every 4 to 8 weeks (such as e.g. 3 mg/kg every 4 weeks, 6 mg/kgevery 4 weeks, or 6 mg/kg every 8 weeks) and wherein CRP levels in serumare decreased by and maintained at 50% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels. The invention alsorelates to a polypeptide with SEQ ID NO: 34 for treatment of diseasesand/or disorders associated with IL-6 mediated signaling, wherein thepolypeptide is administered in an amount from about 3 mg/kg to about 6mg/kg every 4 to 8 weeks (such as e.g. 3 mg/kg every 4 weeks, 6 mg/kgevery 4 weeks, or 6 mg/kg every 8 weeks) and wherein CRP levels in serumare decreased by and maintained at 50% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels.

In one aspect of the invention, the polypeptide with SEQ ID NO: 34 isadministered in an amount from about 3 mg/kg to about 6 mg/kg every 4 to8 weeks (such as e.g. 3 mg/kg every 4 weeks, 6 mg/kg every 4 weeks, or 6mg/kg every 8 weeks) and CRP levels in serum are decreased by andmaintained at 50% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels, at 30% or more, 40% or more, 50% ormore, 60% or more, or even 70% or more reduction compared to baseline(i.e. pre-treatment or normal) levels.

In one aspect of the invention, the polypeptide with SEQ ID NO: 34 isadministered in an amount from about 3 mg/kg to about 6 mg/kg (such as 3mg/kg or 6 mg/kg) and CRP levels in serum are decreased by andmaintained at 50% or more reduction compared to baseline (i.e.pre-treatment or normal) levels for up to at least 4 weeks or more, suchas at least 5 weeks after administration, preferably at least 6 weeks orat least 7 weeks after administration, and most preferably at least 8weeks after administration.

In one aspect of the invention, the polypeptide with SEQ ID NO: 34 isadministered in an amount from about 3 mg/kg to about 6 mg/kg (such as 3mg/kg or 6 mg/kg) and CRP levels in serum are decreased by andmaintained at 50% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels, at 30% or more, 40% or more, 50% ormore, 60% or more, or even 70% or more reduction compared to baseline(i.e. pre-treatment or normal) levels, for up to at least 4 weeks ormore.

In a further aspect, the invention relates to a method for inhibitingIL-6 mediated signaling in a subject, said method comprisingadministering to the subject a polypeptide with SEQ ID NO: 34 in anamount from about 3 mg/kg to about 6 mg/kg every 4 to 8 weeks (such ase.g. 3 mg/kg every 4 weeks, 6 mg/kg every 4 weeks, or 6 mg/kg every 8weeks), wherein ESR levels in serum are decreased by and maintained at30% or more (reduction) compared to baseline (i.e. pre-treatment ornormal) levels. The invention thus also relates to a polypeptide withSEQ ID NO: 34 for inhibiting IL-6 mediated signaling, wherein thepolypeptide is administered in an amount from about 3 mg/kg to about 6mg/kg every 4 to 8 weeks (such as e.g. 3 mg/kg every 4 weeks, 6 mg/kgevery 4 weeks, or 6 mg/kg every 8 weeks) and wherein ESR levels in serumare decreased by and maintained at 30% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels. The invention alsorelates to a polypeptide with SEQ ID NO: 34 for treatment of diseasesand/or disorders associated with IL-6 mediated signaling, wherein thepolypeptide is administered in an amount from about 3 mg/kg to about 6mg/kg every 4 to 8 weeks (such as e.g. 3 mg/kg every 4 weeks, 6 mg/kgevery 4 weeks, or 6 mg/kg every 8 weeks) and wherein ESR levels in serumare decreased by and maintained at 30% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels.

In one aspect of the invention, the polypeptide with SEQ ID NO: 34 isadministered in an amount from about 3 mg/kg to about 6 mg/kg every 4 to8 weeks (such as e.g. 3 mg/kg every 4 weeks, 6 mg/kg every 4 weeks, or 6mg/kg every 8 weeks) and ESR levels in serum are decreased by andmaintained at 30% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels, such as at 40% or more, 50% or more,60% or more, or even 70% or more reduction compared to baseline (i.e.pre-treatment or normal) levels.

In one aspect of the invention, the polypeptide with SEQ ID NO: 34 isadministered in an amount from about 3 mg/kg to about 6 mg/kg (such as 3mg/kg or 6 mg/kg) and ESR levels in serum are decreased by andmaintained at 30% or more reduction compared to baseline (i.e.pre-treatment or normal) levels for up to at least 4 weeks or more, suchas at least 5 weeks after administration, preferably at least 6 weeks orat least 7 weeks after administration, and most preferably at least 8weeks after administration.

In one aspect of the invention, the polypeptide with SEQ ID NO: 34 isadministered in an amount from about 3 mg/kg to about 6 mg/kg (such as 3mg/kg or 6 mg/kg) and ESR levels in serum are decreased by andmaintained at 30% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels, such as at 40% or more, 50% or more,60% or more, or even 70% or more reduction compared to baseline (i.e.pre-treatment or normal) levels, for up to at least 4 weeks or more.

In a further aspect, the invention relates to a method for inhibitingIL-6 mediated signaling in a subject, said method comprisingadministering to the subject a polypeptide with SEQ ID NO: 34 in anamount from about 3 mg/kg to about 6 mg/kg every 4 to 8 weeks (such ase.g. 3 mg/kg every 4 weeks, 6 mg/kg every 4 weeks, or 6 mg/kg every 8weeks), wherein fibrinogen levels in serum are decreased by andmaintained at 30% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels. The invention thus also relates to apolypeptide with SEQ ID NO: 34 for inhibiting IL-6 mediated signaling,wherein the polypeptide is administered in an amount from about 3 mg/kgto about 6 mg/kg every 4 to 8 weeks (such as e.g. 3 mg/kg every 4 weeks,6 mg/kg every 4 weeks, or 6 mg/kg every 8 weeks) and wherein fibrinogenlevels in serum are decreased by and maintained at 30% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levels.The invention also relates to a polypeptide with SEQ ID NO: 34 fortreatment of diseases and/or disorders associated with IL-6 mediatedsignaling, wherein the polypeptide is administered in an amount fromabout 3 mg/kg to about 6 mg/kg every 4 to 8 weeks (such as e.g. 3 mg/kgevery 4 weeks, 6 mg/kg every 4 weeks, or 6 mg/kg every 8 weeks) andwherein fibrinogen levels in serum are decreased by and maintained at30% or more (reduction) compared to baseline (i.e. pre-treatment ornormal) levels.

In one aspect of the invention, the polypeptide with SEQ ID NO: 34 isadministered in an amount from about 3 mg/kg to about 6 mg/kg every 4 to8 weeks (such as e.g. 3 mg/kg every 4 weeks, 6 mg/kg every 4 weeks, or 6mg/kg every 8 weeks) and fibrinogen levels in serum are decreased by andmaintained at 30% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels, at 20% or more, 30% or more, 40% ormore, or even 50% or more reduction compared to baseline (i.e.pre-treatment or normal) levels.

In one aspect of the invention, the polypeptide with SEQ ID NO: 34 isadministered in an amount from about 3 mg/kg to about 6 mg/kg (such as 3mg/kg or 6 mg/kg) and fibrinogen levels in serum are decreased by andmaintained at 30% or more reduction compared to baseline (i.e.pre-treatment or normal) levels for up to at least 4 weeks or more, suchas at least 5 weeks after administration, preferably at least 6 weeks orat least 7 weeks after administration, and most preferably at least 8weeks after administration.

In one aspect of the invention, the polypeptide with SEQ ID NO: 34 isadministered in an amount from about 3 mg/kg to about 6 mg/kg (such as 3mg/kg or 6 mg/kg) and fibrinogen levels in serum are decreased by andmaintained at 30% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels, at 20% or more, 30% or more, 40% ormore, or even 50% or more reduction compared to baseline (i.e.pre-treatment or normal) levels for up to at least 4 weeks or more.

In a further aspect, the invention relates to a method for inhibitingIL-6 mediated signaling in a subject, said method comprisingadministering to the subject a polypeptide with SEQ ID NO: 34 in anamount from about 3 mg/kg to about 6 mg/kg every 4 to 8 weeks (such ase.g. 3 mg/kg every 4 weeks, 6 mg/kg every 4 weeks, or 6 mg/kg every 8weeks), wherein serum amyloid A levels are decreased by and maintainedat 30% or more (reduction) compared to baseline (i.e. pre-treatment ornormal) levels. The invention thus also relates to a polypeptide withSEQ ID NO: 34 for inhibiting IL-6 mediated signaling, wherein thepolypeptide is administered in an amount from about 3 mg/kg to about 6mg/kg every 4 to 8 weeks (such as e.g. 3 mg/kg every 4 weeks, 6 mg/kgevery 4 weeks, or 6 mg/kg every 8 weeks) and wherein serum amyloid Alevels are decreased by and maintained at 30% or more (reduction)compared to baseline (i.e. pre-treatment or normal) levels. Theinvention also relates to a polypeptide with SEQ ID NO: 34 for treatmentof diseases and/or disorders associated with IL-6 mediated signaling,wherein the polypeptide is administered in an amount from about 3 mg/kgto about 6 mg/kg every 4 to 8 weeks (such as e.g. 3 mg/kg every 4 weeks,6 mg/kg every 4 weeks, or 6 mg/kg every 8 weeks) and wherein serumamyloid A levels are decreased by and maintained at 30% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levels.

In one aspect of the invention, the polypeptide with SEQ ID NO: 34 isadministered in an amount from about 3 mg/kg to about 6 mg/kg every 4 to8 weeks (such as e.g. 3 mg/kg every 4 weeks, 6 mg/kg every 4 weeks, or 6mg/kg every 8 weeks) and serum amyloid A levels are decreased by andmaintained at 30% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels, such as at 40% or more, 50% or more,60% or more, or even 70% or more reduction compared to baseline (i.e.pre-treatment or normal) levels.

In one aspect of the invention, the polypeptide with SEQ ID NO: 34 isadministered in an amount from about 3 mg/kg to about 6 mg/kg (such as 3mg/kg or 6 mg/kg) and serum amyloid A levels are decreased by andmaintained at 30% or more reduction compared to baseline (i.e.pre-treatment or normal) levels for up to at least 4 weeks or more, suchas at least 5 weeks after administration, preferably at least 6 weeks orat least 7 weeks after administration, and most preferably at least 8weeks after administration.

In one aspect of the invention, the polypeptide with SEQ ID NO: 34 isadministered in an amount from about 3 mg/kg to about 6 mg/kg (such as 3mg/kg or 6 mg/kg) and serum amyloid A levels are decreased by andmaintained at 30% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels, such as at 40% or more, 50% or more,60% or more, or even 70% or more reduction compared to baseline (i.e.pre-treatment or normal) levels for up to at least 4 weeks or more.

FIGURE LEGENDS

FIG. 1. Relationship of soluble IL-6 receptor, free tocilizumab andC-reactive protein in serum following a single infusion of tocilizumab(10 mg/kg) to rheumatoid arthritis patients (n=12). sIL-6: Soluble IL-6.Data taken from Schmitt et al. (2010, Clin. Pharmacol. Ther. 89:735-740).

FIG. 2. Median IL6R304 plasma profiles expected after repeated IL6R304administration of 1 mg/kg (39 nmol/kg) Q4W, 3 mg/kg (117 nmol/kg) Q4Wand 6 mg/kg (233 nmol/kg) Q8W. The median tocilizumab (TCZ) profileafter repeated dose of 8 mg/kg (107 nmol/kg) Q4W, reproduced from apublished model, is added for comparison (Frey N., Grange S. andWoodworth T. 2010, Population Pharmacokinetic Analysis of Tocilizumab inPatients with Rheumatoid Arthritis. J. Clin. Pharm. 50: 754-766).

FIG. 3. Median sIL-6R plasma profiles expected after repeated IL6R304administration of 1 mg/kg (39 nmol/kg) Q4W, 3 mg/kg (117 nmol/kg) Q4Wand 6 mg/kg (233 nmol/kg) Q8W. The median tocilizumab (TCZ) profileafter repeated dose of 4 mg/kg (54 nmol/kg) Q4W or 8 mg/kg (107 nmol/kg)Q4W, reproduced from a published model (Levi et al. 2012, J. Clin.Pharmacol. February 14. [Epub ahead of print]; Gibiansky and Frey 2012,J. Pharmacokinet. Pharmacodyn. 39(1): 5-16; Zhang and Peck 2011, ExpertRev. Clin. Pharmacol. 4(5): 539-55), is added for comparison.

FIG. 4. C-Reactive Protein (CRP) changes (in %) from baseline (i.e. %reduction compared to baseline) in the different patient groups duringthe SAD study with IL6R304 as described in Example 4.

FIG. 5. DAS28 and CRP changes (in %) from baseline (i.e. % reductioncompared to baseline) in the 6 mg/kg dosing group during the SAD studywith IL6R304.

FIG. 6. Changes in IL-6 levels (pg/ml) for the different treatmentgroups during the SAD study with IL6R304. Visit 1: Day −28 to −2; Visit2: Day 1 (pre-dose); Visit 3: Day 1 (8 hrs post-dose); Visit 4:Unscheduled Lab 1; Visit 5: Day 2 (24 hrs post-dose); Visit 6: Day 3 (48hrs post-dose); Visit 7: Day 4 (72 hrs post-dose); Visit 8: Day 8; Visit9: Day 15; Visit 10: Day 29; Visit 11: Day 36; Visit 12: Day 57; Visit13: Follow-up.

FIG. 7. Changes in sIL-6R levels (ng/ml) for the different treatmentgroups during the SAD study with IL6R304. Visit 1: Day −28 to −2; Visit2: Day 1 (pre-dose); Visit 3: Day 1 (8 hrs post-dose); Visit 4:Unscheduled Lab 1; Visit 5: Day 2 (24 hrs post-dose); Visit 6: Day 3 (48hrs post-dose); Visit 7: Day 4 (72 hrs post-dose); Visit 8: Day 8; Visit9: Day 15; Visit 10: Day 29; Visit 11: Day 36; Visit 12: Day 57; Visit13: Follow-up.

FIG. 8. Mean (±SE) DAS28 and CRP changes (in %) from baseline (i.e. %reduction compared to baseline). Single symbols indicated DAS28 scores.Lines with symbols indicate CRP changes.

DETAILED DESCRIPTION Methods of the Invention

The Applicant has discovered that the administration to human subjectsof polypeptides as described herein that specifically bind IL-6R(referred to herein as “polypeptide(s) of the invention” as furtherdefined herein) provides an unexpectedly sustained, prolonged effect oninhibition of IL-6 mediated signaling in the human subjects as observedthrough changes in relevant biomarkers (such as serum IL-6R, serum IL-6,serum CRP, serum ESR, serum fibrinogen and/or serum amyloid A).Therefore, the invention relates to the use of the polypeptides of theinvention to inhibit IL-6 mediated signaling in a subject forunexpectedly prolonged periods of time, particularly in view of thedoses administered. The invention also provides for less frequent and/orlower dose administration to a subject of the polypeptides of theinvention, while still maintaining effective inhibition of IL-6 mediatedsignaling in the subject at unexpectedly prolonged periods of time.Accordingly, methods are provided for inhibiting IL-6 mediated signalingin a subject by administering to the subject a polypeptide of theinvention that specifically binds IL-6R, wherein the amount of thepolypeptide administered is effective to change one or more markers ofIL-6 mediated signaling, such as total sIL-6R, total IL-6, CRP, ESR,fibrinogen and/or serum amyloid A for unexpectedly prolonged periods oftime.

Various biomarkers are available for measuring IL-6 mediated signaling.In a preferred aspect, markers of IL-6 mediated signaling are selectedfrom soluble interleukin-6 receptor (sIL-6R), interleukin-6 (IL-6),C-reactive protein (CRP), Erythrocytes Sedimentation Rate (ESR),fibrinogen and Serum Amyloid A. These markers can be measured usingstandard methods known to and used by the skilled person, such asvarious immunologically based assays, including enzyme-linkedimmunosorbent assays (ELISA; also known as an enzyme immunoassay (EIA)),radioimmunoassays or immunoenzymetric assays. Chemical, colorimetric andenzymatic based assays also may be used when suitable.

Soluble IL-6R (sIL-6R) includes serum IL-6R free from IL-6 and serumIL-6R free from polypeptide of the invention as well as serum IL-6R incomplex with IL-6, serum IL-6R in complex with IL-6 and gp130 and serumIL-6R in an immune complex with the polypeptide of the invention. SerumsIL-6R is free or bound to IL-6 before administration of the polypeptideof the invention. Following administration of the polypeptide of theinvention, the sIL-6R binds to the polypeptide of the invention to forma sIL-6R/polypeptide of the invention immune complex.

Serum sIL-6R levels can be determined by any method as described hereinand/or known in the art. Preferred and easy methods for determiningsIL-6R levels include immunoassays such as flow cytometry, inhibitionassay, immunoprecipitation, immunohistochemistry (Frozen) and ELISA(such as e.g. the Quantikine Human IL-6sR kit from R&D Systems,Minneapolis, Minn.; E91815Hu ELISA Kit for Interleukin 6 Receptor (IL6R)from Uscn Life Science Inc, Wuhan, China; SEK10398 human IL6R/CD126ELISA kit from Sino Biological, Inc., Beijing, China; EL10034Interleukin 6 Soluble Receptor (IL 6 sR) ELISA Kit, human fromBiosupply, UK; or any other assay such as e.g. the assays described inthe example section).

IL-6 includes serum IL-6 free from IL-6R as well as serum IL-6 incomplex with IL-6R and serum IL-6 in complex with IL-6R and sgp130.Serum IL-6 levels are free or bound to IL-6R before administration ofthe polypeptide of the invention. Following administration of thepolypeptide of the invention IL-6 temporarily increases. This increaseis most likely caused by IL-6R blockade inhibiting clearance of IL-6from the blood.

Serum IL-6 levels can be determined by any method as described hereinand/or known in the art. Preferred and easy methods for determining IL-6levels include immunoassays such as flow cytometry, inhibition assay,immunoprecipitation, immunohistochemistry (Frozen) and ELISA (such ase.g. Human IL-6 Quantiglo ELISA Kit” from R&D Systems, Minneapolis,Minn. (cat# Q6000B); Human IL-6 ELISA Ready-SET-Go!® from eBioscienceLtd., Hatfield, United Kingdom; Human Interleukin-6 (IL6/IFNB2) ELISAKit from Sino Biological Inc., Beijing, China; Interleukin 6 (IL 6)ELISA Kit, human from Biosupply, UK).

C-reactive protein (CRP) is an acute-phase protein found in the blood,of which the levels rise in response to inflammation. C-reactive protein(CRP) is synthesized by hepatocytes as a direct effect of IL-6stimulation. Elevated CRP levels are an indication of inflammationintensity in RA. It has been demonstrated that blockade of IL-6 mediatedsignaling (such as by blockade of IL-6R) can lower CRP levels (Nishimotoet al. 2008, Blood 112: 3959-3964).

The level of C-reactive protein in serum can be determined by any methodas described herein and/or known in the art. Preferred and easy methodsinclude immunoassays such as the C-reactive protein detection kit (DifcoLaboratories, Detroit, Mich., US), the Human C-Reactive Protein ELISAKit (Abnova Corporation, Taipei, Taiwan R.O.C.), the Human CRP ELISAKit, High sensitivity (American Diagnostic GmbH, Pfungstadt, Germany),the Human CRP ELISA Kit (Antigenix America Inc., NY, US) and the IMMAGEImmunochemistry System (Beckman Coulter Inc., Brea, Calif., US).

Erythrocytye Sedimentation Rate (ESR) is the rate at which red bloodcells sediment in a period of 1 hour. It is a common hematology test,and is a non-specific measure of inflammation. To perform the test,anticoagulated blood is placed in an upright tube, known as a Westergrentube, and the rate at which the red blood cells fall is measured andreported in mm/h. The ESR is governed by the balance betweenpro-sedimentation factors, mainly fibrinogen, and those factorsresisting sedimentation, namely the negative charge of the erythrocytes(zeta potential). When an inflammatory process is present, the highproportion of fibrinogen in the blood causes red blood cells to stick toeach other. The red cells form stacks called ‘rouleaux,’ which settlefaster.

The ESR can further be determined (without being limiting) with theGreiner ESR tube (Cat. No. 454076), or with the Preanalytics—VACUETTE®Evacuated Collection Tubes (Greiner Bio-One, Wemmel, Belgium), withSediplus® S 2000 (Sarstedt; Nümbrecht, Germany), or with Seditainer™(Product Number: 366016; Becton Dickinson, NJ USA).

Fibrinogen (factor I) is a soluble 340 kDa glycoprotein, synthesized inthe liver by hepatocytes, that is converted by thrombin into fibrinduring blood coagulation. The concentration in blood plasma is 1.5-4.0g/L (normally measured using the Clauss method) or about 7 μM. Recentresearch has shown that fibrin plays a key role in the inflammatoryresponse and development of rheumatoid arthritis. It may be elevated inany form of inflammation, as it is an acute-phase protein (Gilliam etal. 2011, Pediatric Rheumatology 9: 8).

The fibrinogen level can be determined by any method as described aboveand/or known in the art. Preferred and easy methods include (withoutbeing limiting) the STA® Fibrinogen 5 (Stago, Parsippany, N.J., USA) forquantitative determination of fibrinogen by the Clauss method, the STACompact®, a fully automated, benchtop, Haemostasis analyser forclotting, chromogenic and immunological assays using random access mode(Stago, Parsippany, N.J., USA), ACL TOP® 500 CTS (Beckman Coulter Inc.,Brea, Calif., US) and Ceveron® alpha (TC technoclone, Vienna, Austria).

Serum amyloid A (SAA) proteins are a family of apolipoproteinsassociated with high-density lipoprotein (HDL) in plasma. Acute-phaseserum amyloid A proteins (A-SAAs) are secreted during the acute phase ofinflammation. A-SAAs are implicated in several chronic inflammatorydiseases, such as amyloidosis, atherosclerosis, and rheumatoid arthritis(Zhang et al. 2005, J. Immunol. 174: 8125-34).

The level of serum amyloid A in serum can be determined by any method asdescribed above and/or known in the art. Preferred and easy methodsinclude the Phase SAA Assay (Tridelta Development Ltd. Maynooth, CountyKildare, Ireland; Cat. no. TP-802), or the ELISA assay as described inthe Examples section.

In one aspect, methods are provided for inhibiting IL-6 mediatedsignaling in a subject by administering to the subject a polypeptide ofthe invention, wherein the amount of the polypeptide administered iseffective to increase total sIL-6R levels in serum to at least 400 ng/mland maintain total sIL-6R levels in serum at at least 400 ng/ml.Preferably total sIL-6R levels are increased to and maintained at atleast 450 ng/ml, at least 500 ng/ml, more preferably at least 550 ng/mlor even at least 600 ng/ml, at least 650 ng/ml, or even at least 700ng/ml or more.

In another aspect, methods are provided for inhibiting IL-6 mediatedsignaling in a subject by administering to the subject a polypeptide ofthe invention, wherein the amount of the polypeptide administered iseffective to increase total IL-6 levels in serum to at least 40 pg/mland maintain total IL-6 levels in serum at at least 40 pg/ml. Preferablytotal IL-6 levels are increased to and maintained at at least 45 pg/ml,at least 50 pg/ml, more preferably at least 55 pg/ml or even at least 60pg/ml or more.

In yet another aspect, methods are provided for inhibiting IL-6 mediatedsignaling in a subject by administering to the subject a polypeptide ofthe invention, wherein the amount of the polypeptide administered iseffective to reduce CRP levels below 10 mg/l and maintain CRP levelsbelow 10 mg/l. Preferably CRP levels are reduced to and maintained below9 mg/l or below 8 mg/l, more preferably below 7.5 mg/l, below 7 mg/l orbelow 6.5 mg/l, or even below 6 mg/l, below 5.5 mg/l, below 5 mg/l orless.

In a specific aspect, when the subject is also receiving methotrexate(MTX) therapy, the baseline CRP levels (i.e. the CRP levels beforedosing the polypeptide of the invention) in serum are most likelyalready below 10 mg/ml or less (unrelated to the anti-IL-6R therapy).Accordingly, “reduction of CRP levels in serum below 10 mg/l or less andmaintenance of CRP levels in serum below 10 mg/l or less” cannot be usedas a relevant marker for the pharmacodynamic effect of the polypeptideof the invention in such subjects (that also receive MTX therapy), butonly in subjects that do not receive methotrexate (MTX) therapy.

Therefore, in certain cases (such as when the subject is also receivingMTX therapy), changes in CRP levels can also be determined as “%reduction compared to baseline (i.e. compared to CRP levels beforetreatment with the polypeptide of the invention (pre-treatment) and/orat normal levels)”.

Accordingly, in yet another aspect, methods are provided for inhibitingIL-6 mediated signaling in a subject by administering to the subject apolypeptide of the invention, wherein the amount of the polypeptideadministered is effective to reduce CRP levels in serum by 50% or morecompared to baseline (i.e. pre-treatment or normal) levels and tomaintain CRP levels in serum at 50% or more reduction compared tobaseline levels. Preferably CRP levels are reduced by and maintained at30% or more, 40% or more, 50% or more, 60% or more, or even 70% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levels.

In yet another aspect, methods are provided for inhibiting IL-6 mediatedsignaling in a subject by administering to the subject a polypeptide ofthe invention, wherein the amount of the polypeptide administered iseffective to reduce ESR levels in serum by 30% or more compared tobaseline (i.e. pre-treatment or normal) levels and to maintain ESRlevels in serum at 30% or more reduction compared to baseline levels.Preferably ESR levels are reduced by and maintained at 40% or more, 50%or more, 60% or more, or even 70% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels.

In yet another aspect, methods are provided for inhibiting IL-6 mediatedsignaling in a subject by administering to the subject a polypeptide ofthe invention, wherein the amount of the polypeptide administered iseffective to reduce fibrinogen levels in serum by 30% or more comparedto baseline (i.e. pre-treatment or normal) levels and to maintainfibrinogen levels in serum at 30% or more reduction compared to baselinelevels. Preferably fibrinogen levels are reduced by and maintained at20% or more, 30% or more, 40% or more, or even 50% or more (reduction)compared to baseline (i.e. pre-treatment or normal) levels.

In yet another aspect, methods are provided for inhibiting IL-6 mediatedsignaling in a subject by administering to the subject a polypeptide ofthe invention, wherein the amount of the polypeptide administered iseffective to reduce serum amyloid A levels by 30% or more compared tobaseline (i.e. pre-treatment or normal) levels and to maintain serumamyloid A levels at 30% or more reduction compared to baseline levels.Preferably serum amyloid A levels are reduced by and maintained at 40%or more, 50% or more, 60% or more, or even 70% or more (reduction)compared to baseline (i.e. pre-treatment or normal) levels.

In another aspect, methods for inhibiting IL-6 mediated signaling in asubject are provided that include administering to the subject apolypeptide of the invention, wherein the amount of the polypeptideadministered is effective to change one or more markers of IL-6 mediatedsignaling for at least 4 weeks after administration. Certain amounts ofthe polypeptide of the invention may change the one or more markers ofIL-6 mediated signaling for longer periods of time, such as at least 5weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least 9weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeks;for example (including the ends of each range) 4-5 weeks, 5-6 weeks, 6-7weeks, 7-8 weeks, 8-9 weeks, 9-10 weeks, 10-11 weeks, 11-12 weeks, 4-6weeks, 5-7 weeks, 6-8 weeks, 7-9 weeks, 8-10 weeks, 9-11 weeks, 10-12weeks, 4-7 weeks, 5-8 weeks, 6-9 weeks, 7-10 weeks, 8-11 weeks, 9-12weeks, 4-8 weeks, 5-9 weeks, 6-10 weeks, 7-11 weeks, 8-12 weeks, 4-9weeks, 5-10 weeks, 6-11 weeks, 7-12 weeks, 4-10 weeks, 5-11 weeks, 6-12weeks, 4-11 weeks, 5-12 weeks, 4-12 weeks.

Accordingly, the present invention provides methods for inhibiting IL-6mediated signaling in a subject that include administering to thesubject a polypeptide of the invention, wherein the amount of thepolypeptide administered is effective to increase total sIL-6R levels inserum for at least 4 weeks after administration. In some embodiments,the serum level of sIL-6R is increased to and maintained at at least 400ng/ml or more, such as at least 450 ng/ml, at least 500 ng/ml, morepreferably at least 550 ng/ml, at least 600 ng/ml, at least 650 ng/ml,or even at least 700 ng/ml or more. The increase in the serum level ofsIL-6R can persist for longer periods of time, such as at least 5 weeks,at least 6 weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks,at least 10 weeks, at least 11 weeks, or even at least 12 weeks; forexample (including the ends of each range) 4-5 weeks, 5-6 weeks, 6-7weeks, 7-8 weeks, 8-9 weeks, 9-10 weeks, 10-11 weeks, 11-12 weeks, 4-6weeks, 5-7 weeks, 6-8 weeks, 7-9 weeks, 8-10 weeks, 9-11 weeks, 10-12weeks, 4-7 weeks, 5-8 weeks, 6-9 weeks, 7-10 weeks, 8-11 weeks, 9-12weeks, 4-8 weeks, 5-9 weeks, 6-10 weeks, 7-11 weeks, 8-12 weeks, 4-9weeks, 5-10 weeks, 6-11 weeks, 7-12 weeks, 4-10 weeks, 5-11 weeks, 6-12weeks, 4-11 weeks, 5-12 weeks, 4-12 weeks.

In a specific aspect, the levels of sIL-6R are increased to andmaintained at at least 400 ng/ml for up to at least 5 weeks, at least 6weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, at least 10weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, the levels of sIL-6R are increased to andmaintained at at least 450 ng/ml for up to at least 5 weeks, at least 6weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, at least 10weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, the levels of sIL-6R are increased to andmaintained at at least 500 ng/ml for up to at least 5 weeks, at least 6weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, at least 10weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, the levels of sIL-6R are increased to andmaintained at at least 550 ng/ml for up to at least 5 weeks, at least 6weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, at least 10weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, the levels of sIL-6R are increased to andmaintained at at least 600 ng/ml or more for up to at least 5 weeks, atleast 6 weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, atleast 10 weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, the levels of sIL-6R are increased to andmaintained at at least 650 ng/ml or more for up to at least 5 weeks, atleast 6 weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, atleast 10 weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, the levels of sIL-6R are increased to andmaintained at at least 700 ng/ml or more for up to at least 5 weeks, atleast 6 weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, atleast 10 weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another aspect of the invention, methods for inhibiting IL-6 mediatedsignaling in a subject are provided that include administering to thesubject a polypeptide of the invention, wherein the amount of thepolypeptide administered is effective to increase total IL-6 levels inserum for at least 4 weeks after administration. In some embodiments,the serum level of IL-6 is increased to and maintained at at least 40pg/ml or more, such as at least 45 pg/ml, at least 50 pg/ml, morepreferably at least 55 pg/ml or even at least 60 pg/ml or more. Theincrease in the serum level of IL-6 can persist for longer periods oftime, such as at least 5 weeks, at least 6 weeks, at least 7 weeks, atleast 8 weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks,or even at least 12 weeks; for example (including the ends of eachrange) 4-5 weeks, 5-6 weeks, 6-7 weeks, 7-8 weeks, 8-9 weeks, 9-10weeks, 10-11 weeks, 11-12 weeks, 4-6 weeks, 5-7 weeks, 6-8 weeks, 7-9weeks, 8-10 weeks, 9-11 weeks, 10-12 weeks, 4-7 weeks, 5-8 weeks, 6-9weeks, 7-10 weeks, 8-11 weeks, 9-12 weeks, 4-8 weeks, 5-9 weeks, 6-10weeks, 7-11 weeks, 8-12 weeks, 4-9 weeks, 5-10 weeks, 6-11 weeks, 7-12weeks, 4-10 weeks, 5-11 weeks, 6-12 weeks, 4-11 weeks, 5-12 weeks, 4-12weeks.

In a specific aspect, the levels of IL-6 are increased to and maintainedat at least 40 pg/ml for up to at least 5 weeks, at least 6 weeks, atleast 7 weeks, at least 8 weeks, at least 9 weeks, at least 10 weeks, atleast 11 weeks, or even at least 12 weeks after administration.

In another specific aspect, the levels of IL-6 are increased to andmaintained at at least 45 pg/ml for up to at least 5 weeks, at least 6weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, at least 10weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, the levels of IL-6 are increased to andmaintained at at least 50 pg/ml for up to at least 5 weeks, at least 6weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, at least 10weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, the levels of IL-6 are increased to andmaintained at at least 55 pg/ml for up to at least 5 weeks, at least 6weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, at least 10weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, the levels of IL-6 are increased to andmaintained at at least 60 pg/ml or more for up to at least 5 weeks, atleast 6 weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, atleast 10 weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another aspect of the invention, methods for inhibiting IL-6 mediatedsignaling in a subject are provided that include administering to thesubject a polypeptide of the invention, wherein the amount of thepolypeptide administered is effective to reduce CRP levels in serum forat least 4 weeks after administration. In some embodiments, the serumlevel of CRP are reduced to and maintained below 10 mg/l, such as below9 mg/l or below 8 mg/l, more preferably below 7.5 mg/l, below 7 mg/l orbelow 6.5 mg/l, or even below 6 mg/l, below 5.5 mg/l, below 5 mg/l orless. The reduction in the serum level of CRP can persist for longerperiods of time, such as at least 5 weeks, at least 6 weeks, at least 7weeks, at least 8 weeks, at least 9 weeks, at least 10 weeks, at least11 weeks, or even at least 12 weeks; for example (including the ends ofeach range) 4-5 weeks, 5-6 weeks, 6-7 weeks, 7-8 weeks, 8-9 weeks, 9-10weeks, 10-11 weeks, 11-12 weeks, 4-6 weeks, 5-7 weeks, 6-8 weeks, 7-9weeks, 8-10 weeks, 9-11 weeks, 10-12 weeks, 4-7 weeks, 5-8 weeks, 6-9weeks, 7-10 weeks, 8-11 weeks, 9-12 weeks, 4-8 weeks, 5-9 weeks, 6-10weeks, 7-11 weeks, 8-12 weeks, 4-9 weeks, 5-10 weeks, 6-11 weeks, 7-12weeks, 4-10 weeks, 5-11 weeks, 6-12 weeks, 4-11 weeks, 5-12 weeks, 4-12weeks.

In a specific aspect, the levels of CRP are reduced to and maintainedbelow 10 mg/l for up to at least 5 weeks, at least 6 weeks, at least 7weeks, at least 8 weeks, at least 9 weeks, at least 10 weeks, at least11 weeks, or even at least 12 weeks after administration.

In another specific aspect, the levels of CRP are reduced to andmaintained below 9 mg/l for up to at least 5 weeks, at least 6 weeks, atleast 7 weeks, at least 8 weeks, at least 9 weeks, at least 10 weeks, atleast 11 weeks, or even at least 12 weeks after administration.

In another specific aspect, the levels of CRP are reduced to andmaintained below 8 mg/l for up to at least 5 weeks, at least 6 weeks, atleast 7 weeks, at least 8 weeks, at least 9 weeks, at least 10 weeks, atleast 11 weeks, or even at least 12 weeks after administration.

In another specific aspect, the levels of CRP are reduced to andmaintained below 7.5 mg/l for up to at least 5 weeks, at least 6 weeks,at least 7 weeks, at least 8 weeks, at least 9 weeks, at least 10 weeks,at least 11 weeks, or even at least 12 weeks after administration.

In another specific aspect, the levels of CRP are reduced to andmaintained below 7 mg/l for up to at least 5 weeks, at least 6 weeks, atleast 7 weeks, at least 8 weeks, at least 9 weeks, at least 10 weeks, atleast 11 weeks, or even at least 12 weeks after administration.

In another specific aspect, the levels of CRP are reduced to andmaintained below 6.5 mg/l for up to at least 5 weeks, at least 6 weeks,at least 7 weeks, at least 8 weeks, at least 9 weeks, at least 10 weeks,at least 11 weeks, or even at least 12 weeks after administration.

In another specific aspect, the levels of CRP are reduced to andmaintained below 6 mg/l for up to at least 5 weeks, at least 6 weeks, atleast 7 weeks, at least 8 weeks, at least 9 weeks, at least 10 weeks, atleast 11 weeks, or even at least 12 weeks after administration.

In another specific aspect, the levels of CRP are reduced to andmaintained below 5.5 mg/l for up to at least 5 weeks, at least 6 weeks,at least 7 weeks, at least 8 weeks, at least 9 weeks, at least 10 weeks,at least 11 weeks, or even at least 12 weeks after administration.

In another specific aspect, the levels of CRP are reduced to andmaintained below 5 mg/l or less for up to at least 5 weeks, at least 6weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, at least 10weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In a specific aspect, when the subject is also receiving methotrexate(MTX) therapy, the baseline CRP levels (i.e. the CRP levels beforedosing the polypeptide of the invention) in serum are most likelyalready below 10 mg/ml or less (unrelated to the anti-IL-6R therapy).Accordingly, “reduction of CRP levels in serum below 10 mg/l or less andmaintenance of CRP levels in serum below 10 mg/l or less” cannot be usedas a relevant marker for the pharmacodynamic effect of the polypeptideof the invention in subjects that also receive MTX therapy, but only insubjects that do not receive methotrexate (MTX) therapy.

In another aspect of the invention, methods for inhibiting IL-6 mediatedsignaling in a subject are provided that include administering to thesubject a polypeptide of the invention, wherein the amount of thepolypeptide administered is effective to reduce CRP levels in serum forat least 4 weeks after administration. In some embodiments, the serumlevel of CRP are reduced by and maintained at 30% or more, 40% or more,50% or more, 60% or more, or even 70% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels. The reduction in theserum level of CRP can persist for longer periods of time, such as atleast 5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, atleast 9 weeks, at least 10 weeks, at least 11 weeks, or even at least 12weeks; for example (including the ends of each range) 4-5 weeks, 5-6weeks, 6-7 weeks, 7-8 weeks, 8-9 weeks, 9-10 weeks, 10-11 weeks, 11-12weeks, 4-6 weeks, 5-7 weeks, 6-8 weeks, 7-9 weeks, 8-10 weeks, 9-11weeks, 10-12 weeks, 4-7 weeks, 5-8 weeks, 6-9 weeks, 7-10 weeks, 8-11weeks, 9-12 weeks, 4-8 weeks, 5-9 weeks, 6-10 weeks, 7-11 weeks, 8-12weeks, 4-9 weeks, 5-10 weeks, 6-11 weeks, 7-12 weeks, 4-10 weeks, 5-11weeks, 6-12 weeks, 4-11 weeks, 5-12 weeks, 4-12 weeks.

In a specific aspect, the levels of CRP are reduced by and maintained at30% or more (reduction) compared to baseline (i.e. pre-treatment ornormal) levels for up to at least 5 weeks, at least 6 weeks, at least 7weeks, at least 8 weeks, at least 9 weeks, at least 10 weeks, at least11 weeks, or even at least 12 weeks after administration.

In another specific aspect, the levels of CRP are reduced by andmaintained at 40% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels for up to at least 5 weeks, at least 6weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, at least 10weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, the levels of CRP are reduced by andmaintained at 45% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels for up to at least 5 weeks, at least 6weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, at least 10weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, the levels of CRP are reduced by andmaintained at 50% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels for up to at least 5 weeks, at least 6weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, at least 10weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, the levels of CRP are reduced by andmaintained at 55% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels for up to at least 5 weeks, at least 6weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, at least 10weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, the levels of CRP are reduced by andmaintained at 60% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels for up to at least 5 weeks, at least 6weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, at least 10weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, the levels of CRP are reduced by andmaintained at 70% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels for up to at least 5 weeks, at least 6weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, at least 10weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another aspect of the invention, methods for inhibiting IL-6 mediatedsignaling in a subject are provided that include administering to thesubject a polypeptide of the invention, wherein the amount of thepolypeptide administered is effective to reduce ESR levels in serum forat least 4 weeks after administration. In some embodiments, the serumlevels of ESR are reduced by and maintained at 30% or more, 40% or more,50% or more, 60% or more, or even 70% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels. The reduction in theserum level of ESR can persist for longer periods of time, such as atleast 5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, atleast 9 weeks, at least 10 weeks, at least 11 weeks, or even at least 12weeks; for example (including the ends of each range) 4-5 weeks, 5-6weeks, 6-7 weeks, 7-8 weeks, 8-9 weeks, 9-10 weeks, 10-11 weeks, 11-12weeks, 4-6 weeks, 5-7 weeks, 6-8 weeks, 7-9 weeks, 8-10 weeks, 9-11weeks, 10-12 weeks, 4-7 weeks, 5-8 weeks, 6-9 weeks, 7-10 weeks, 8-11weeks, 9-12 weeks, 4-8 weeks, 5-9 weeks, 6-10 weeks, 7-11 weeks, 8-12weeks, 4-9 weeks, 5-10 weeks, 6-11 weeks, 7-12 weeks, 4-10 weeks, 5-11weeks, 6-12 weeks, 4-11 weeks, 5-12 weeks, 4-12 weeks.

In a specific aspect, the levels of ESR are reduced by and maintained at30% or more (reduction) compared to baseline (i.e. pre-treatment ornormal) levels for up to at least 5 weeks, at least 6 weeks, at least 7weeks, at least 8 weeks, at least 9 weeks, at least 10 weeks, at least11 weeks, or even at least 12 weeks after administration.

In another specific aspect, the levels of ESR are reduced by andmaintained at 40% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels for up to at least 5 weeks, at least 6weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, at least 10weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, the levels of ESR are reduced by andmaintained at 45% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels for up to at least 5 weeks, at least 6weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, at least 10weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, the levels of ESR are reduced by andmaintained at 50% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels for up to at least 5 weeks, at least 6weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, at least 10weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, the levels of ESR are reduced by andmaintained at 55% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels for up to at least 5 weeks, at least 6weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, at least 10weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, the levels of ESR are reduced by andmaintained at 60% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels for up to at least 5 weeks, at least 6weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, at least 10weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, the levels of ESR are reduced by andmaintained at 70% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels for up to at least 5 weeks, at least 6weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, at least 10weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another aspect of the invention, methods for inhibiting IL-6 mediatedsignaling in a subject are provided that include administering to thesubject a polypeptide of the invention, wherein the amount of thepolypeptide administered is effective to reduce fibrinogen levels inserum for at least 4 weeks after administration. In some embodiments,the serum levels of fibrinogen are reduced by and maintained at 20% ormore, 30% or more, 40% or more, or even 50% or more (reduction) comparedto baseline (i.e. pre-treatment or normal) levels. The reduction in theserum level of fibrinogen can persist for longer periods of time, suchas at least 5 weeks, at least 6 weeks, at least 7 weeks, at least 8weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks, or evenat least 12 weeks; for example (including the ends of each range) 4-5weeks, 5-6 weeks, 6-7 weeks, 7-8 weeks, 8-9 weeks, 9-10 weeks, 10-11weeks, 11-12 weeks, 4-6 weeks, 5-7 weeks, 6-8 weeks, 7-9 weeks, 8-10weeks, 9-11 weeks, 10-12 weeks, 4-7 weeks, 5-8 weeks, 6-9 weeks, 7-10weeks, 8-11 weeks, 9-12 weeks, 4-8 weeks, 5-9 weeks, 6-10 weeks, 7-11weeks, 8-12 weeks, 4-9 weeks, 5-10 weeks, 6-11 weeks, 7-12 weeks, 4-10weeks, 5-11 weeks, 6-12 weeks, 4-11 weeks, 5-12 weeks, 4-12 weeks.

In a specific aspect, the levels of fibrinogen are reduced by andmaintained at 20% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels for up to at least 5 weeks, at least 6weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, at least 10weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, the levels of fibrinogen are reduced by andmaintained at 25% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels for up to at least 5 weeks, at least 6weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, at least 10weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, the levels of fibrinogen are reduced by andmaintained at 30% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels for up to at least 5 weeks, at least 6weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, at least 10weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, the levels of fibrinogen are reduced by andmaintained at 35% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels for up to at least 5 weeks, at least 6weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, at least 10weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, the levels of fibrinogen are reduced by andmaintained at 40% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels for up to at least 5 weeks, at least 6weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, at least 10weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, the levels of fibrinogen are reduced by andmaintained at 50% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels for up to at least 5 weeks, at least 6weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, at least 10weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another aspect of the invention, methods for inhibiting IL-6 mediatedsignaling in a subject are provided that include administering to thesubject a polypeptide of the invention, wherein the amount of thepolypeptide administered is effective to reduce serum amyloid A levelsfor at least 4 weeks after administration. In some embodiments, theserum amyloid A levels are reduced by and maintained at 30% or more, 40%or more, 50% or more, 60% or more, 70% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels. The reduction in theserum amyloid A level can persist for longer periods of time, such as atleast 5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, atleast 9 weeks, at least 10 weeks, at least 11 weeks, or even at least 12weeks; for example (including the ends of each range) 4-5 weeks, 5-6weeks, 6-7 weeks, 7-8 weeks, 8-9 weeks, 9-10 weeks, 10-11 weeks, 11-12weeks, 4-6 weeks, 5-7 weeks, 6-8 weeks, 7-9 weeks, 8-10 weeks, 9-11weeks, 10-12 weeks, 4-7 weeks, 5-8 weeks, 6-9 weeks, 7-10 weeks, 8-11weeks, 9-12 weeks, 4-8 weeks, 5-9 weeks, 6-10 weeks, 7-11 weeks, 8-12weeks, 4-9 weeks, 5-10 weeks, 6-11 weeks, 7-12 weeks, 4-10 weeks, 5-11weeks, 6-12 weeks, 4-11 weeks, 5-12 weeks, 4-12 weeks.

In a specific aspect, the serum amyloid A levels are reduced by andmaintained at 30% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels for up to at least 5 weeks, at least 6weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, at least 10weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, the serum amyloid A levels are reduced byand maintained at 40% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels for up to at least 5 weeks, at least 6weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, at least 10weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, the serum amyloid A levels are reduced byand maintained at 45% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels for up to at least 5 weeks, at least 6weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, at least 10weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, the serum amyloid A levels are reduced byand maintained at 50% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels for up to at least 5 weeks, at least 6weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, at least 10weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, the serum amyloid A levels are reduced byand maintained at 55% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels for up to at least 5 weeks, at least 6weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, at least 10weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, the serum amyloid A levels are reduced byand maintained at 60% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels for up to at least 5 weeks, at least 6weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, at least 10weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, the serum amyloid A levels are reduced byand maintained at 70% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels for up to at least 5 weeks, at least 6weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, at least 10weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

Polypeptide of the Invention Immunoglobulin Single Variable Domain

Unless indicated otherwise, the term “immunoglobulin sequence”—whetherused herein to refer to a heavy chain antibody or to a conventional4-chain antibody—is used as a general term to include both the full-sizeantibody, the individual chains thereof, as well as all parts, domainsor fragments thereof (including but not limited to antigen-bindingdomains or fragments such as V_(HH) domains or V_(H)/V_(L) domains,respectively). In addition, the term “sequence” as used herein (forexample in terms like “immunoglobulin sequence”, “antibody sequence”,“variable domain sequence”, “V_(HH) sequence” or “protein sequence”),should generally be understood to include both the relevant amino acidsequence as well as nucleic acids or nucleotide sequences encoding thesame, unless the context requires a more limited interpretation.

The term “immunoglobulin single variable domain”, interchangeably usedwith “single variable domain”, defines molecules wherein the antigenbinding site is present on, and formed by, a single immunoglobulindomain. This sets immunoglobulin single variable domains apart from“conventional” immunoglobulins or their fragments, wherein twoimmunoglobulin domains, in particular two variable domains, interact toform an antigen binding site. Typically, in conventionalimmunoglobulins, a heavy chain variable domain (VH) and a light chainvariable domain (VL) interact to form an antigen binding site. In thiscase, the complementarity determining regions (CDRs) of both VH and VLwill contribute to the antigen binding site, i.e. a total of 6 CDRs willbe involved in antigen binding site formation.

In contrast, the binding site of an immunoglobulin single variabledomain is formed by a single VH or VL domain. Hence, the antigen bindingsite of an immunoglobulin single variable domain is formed by no morethan three CDRs.

The term “immunoglobulin single variable domain” and “single variabledomain” hence does not comprise conventional immunoglobulins or theirfragments which require interaction of at least two variable domains forthe formation of an antigen binding site. However, these terms docomprise fragments of conventional immunoglobulins wherein the antigenbinding site is formed by a single variable domain.

Generally, single variable domains will be amino acid sequences thatessentially consist of 4 framework regions (FR1 to FR4 respectively) and3 complementarity determining regions (CDR1 to CDR3 respectively). Suchsingle variable domains and fragments are most preferably such that theycomprise an immunoglobulin fold or are capable for forming, undersuitable conditions, an immunoglobulin fold. As such, the singlevariable domain may for example comprise a light chain variable domainsequence (e.g. a VL-sequence) or a suitable fragment thereof; or a heavychain variable domain sequence (e.g. a VH-sequence or VHH sequence) or asuitable fragment thereof; as long as it is capable of forming a singleantigen binding unit (i.e. a functional antigen binding unit thatessentially consists of the single variable domain, such that the singleantigen binding domain does not need to interact with another variabledomain to form a functional antigen binding unit, as is for example thecase for the variable domains that are present in for exampleconventional antibodies and scFv fragments that need to interact withanother variable domain—e.g. through a VH/VL interaction—to form afunctional antigen binding domain).

In one embodiment of the invention, the immunoglobulin single variabledomains are light chain variable domain sequences (e.g. a VL-sequence),or heavy chain variable domain sequences (e.g. a VH-sequence); morespecifically, the immunoglobulin single variable domains can be heavychain variable domain sequences that are derived from a conventionalfour-chain antibody or heavy chain variable domain sequences that arederived from a heavy chain antibody.

For a general description of heavy chain antibodies and the variabledomains thereof, reference is inter alia made to the prior art citedherein, as well as to the prior art mentioned on page 59 of WO 08/020079and to the list of references mentioned on pages 41-43 of theInternational application WO 06/040153, which prior art and referencesare incorporated herein by reference.

For example, the single variable domain or immunoglobulin singlevariable domain (or an amino acid sequence that is suitable for use asan immunoglobulin single variable domain) may be a (single) domainantibody (or an amino acid sequence that is suitable for use as a(single) domain antibody), a “dAb” or dAb (or an amino acid sequencethat is suitable for use as a dAb) or a Nanobody (as defined herein, andincluding but not limited to a VHH sequence); other single variabledomains, or any suitable fragment of any one thereof. For a generaldescription of (single) domain antibodies, reference is also made to theprior art cited herein, as well as to EP 0 368 684. For the term“dAb's”, reference is for example made to Ward et al. 1989 (Nature 341(6242): 544-6), to Holt et al. 2003 (Trends Biotechnol. 21(11):484-490); as well as to for example WO 04/068820, WO 06/030220, WO06/003388 and other published patent applications of Domantis Ltd. Itshould also be noted that, although less preferred in the context of thepresent invention because they are not of mammalian origin, singlevariable domains can be derived from certain species of shark (forexample, the so-called “IgNAR domains”, see for example WO 05/18629).

In particular, the immunoglobulin single variable domain may be aNanobody® (as defined herein) or a suitable fragment thereof. [Note:Nanobody®, Nanobodies® and Nanoclone® are registered trademarks ofAblynx N.V.] For a general description of Nanobodies, reference is madeto the further description below, as well as to the prior art citedherein, such as e.g. described in WO 08/020079 (page 16).

The amino acid sequence and structure of an immunoglobulin sequence, inparticular an immunoglobulin single variable domain can beconsidered—without however being limited thereto—to be comprised of fourframework regions or “FR's”, which are referred to in the art and hereinas “Framework region 1” or “FR1”; as “Framework region 2” or “FR2”; as“Framework region 3” or “FR3”; and as “Framework region 4” or “FR4”,respectively; which framework regions are interrupted by threecomplementary determining regions or “CDR's”, which are referred to inthe art as “Complementarity Determining Region 1” or “CDR1”; as“Complementarity Determining Region 2” or “CDR2”; and as“Complementarity Determining Region 3” or “CDR3”, respectively.

The total number of amino acid residues in an immunoglobulin singlevariable domain can be in the region of 110-120, is preferably 112-115,and is most preferably 113. It should however be noted that parts,fragments, analogs or derivatives of an immunoglobulin single variabledomain are not particularly limited as to their length and/or size, aslong as such parts, fragments, analogs or derivatives meet the furtherrequirements outlined herein and are also preferably suitable for thepurposes described herein.

For a further description of VHH's and Nanobodies, reference is made tothe review article by Muyldermans 2001 (Reviews in MolecularBiotechnology 74: 277-302); as well as to the following patentapplications, which are mentioned as general background art: WO94/04678, WO 95/04079 and WO 96/34103 of the Vrije Universiteit Brussel;WO 94/25591, WO 99/37681, WO 00/40968, WO 00/43507, WO 00/65057, WO01/40310, WO 01/44301, EP 1134231 and WO 02/48193 of Unilever; WO97/49805, WO 01/21817, WO 03/035694, WO 03/054016 and WO 03/055527 ofthe Vlaams Instituut voor Biotechnologie (VIB); WO 03/050531 ofAlgonomics N.V. and Ablynx N.V.; WO 01/90190 by the National ResearchCouncil of Canada; WO 03/025020 (=EP 1433793) by the Institute ofAntibodies; as well as WO 04/041867, WO 04/041862, WO 04/041865, WO04/041863, WO 04/062551, WO 05/044858, WO 06/40153, WO 06/079372, WO06/122786, WO 06/122787 and WO 06/122825 by Ablynx N.V., and the furtherpublished patent applications by Ablynx N.V. Reference is also made tothe further prior art mentioned in these applications, and in particularto the list of references mentioned on pages 41-43 of the Internationalapplication WO 06/040153, which list and references are incorporatedherein by reference. As described in these references, Nanobodies (inparticular VHH sequences and partially humanized Nanobodies) can inparticular be characterized by the presence of one or more “Hallmarkresidues” in one or more of the framework sequences. A furtherdescription of the Nanobodies, including humanization and/orcamelization of Nanobodies, as well as other modifications, parts orfragments, derivatives or “Nanobody fusions”, multivalent constructs(including some non-limiting examples of linker sequences) and differentmodifications to increase the half-life of the Nanobodies and theirpreparations can be found e.g. in WO 08/101985 and WO 08/142164.

Thus, in the meaning of the present invention, the term “immunoglobulinsingle variable domain” or “single variable domain” comprisespolypeptides which are derived from a non-human source, preferably acamelid, preferably a camel heavy chain antibody. They may be humanized,as previously described. Moreover, the term comprises polypeptidesderived from non-camelid sources, e.g. mouse or human, which have been“camelized”, as previously described.

The term “immunoglobulin single variable domain” encompassesimmunoglobulin sequences of different origin, comprising mouse, rat,rabbit, donkey, human and camelid immunoglobulin sequences. It alsoincludes fully human, humanized or chimeric immunoglobulin sequences.For example, it comprises camelid immunoglobulin sequences and humanizedcamelid immunoglobulin sequences, or camelized immunoglobulin singlevariable domains, e.g. camelized dAb as described by Ward et al (see forexample WO 94/04678 and Davies and Riechmann 1994, Febs Lett. 339: 285and 1996, Protein Engineering 9: 531).

Immunoglobulin single variable domains (and polypeptides comprising thesame) that are directed against IL-6R have been described in WO08/020079 and WO 2010/115998. Preferred immunoglobulin single variabledomains for use in the polypeptides of the invention include theimproved Nanobodies described in WO 2010/115998.

For example, preferred immunoglobulin single variable domains mayessentially consists of 4 framework regions (FR1 to FR4, respectively)and 3 complementarity determining regions (CDR1 to CDR3, respectively),in which:

a) CDR1 is chosen from the group consisting of: SEQ ID NO's: 17-19;

b) CDR2 is chosen from the group consisting of: SEQ ID NO's: 21-28; and

c) CDR3 is chosen from the group consisting of: SEQ ID NO's: 30-32.

More preferably, the immunoglobulin single variable domain used in thepolypeptide of the invention essentially consists of 4 framework regions(FR1 to FR4, respectively) and 3 complementarity determining regions(CDR1 to CDR3, respectively), in which:

a) CDR1 is chosen from SEQ ID NO: 17;

b) CDR2 is chosen from SEQ ID NO: 21; and

c) CDR3 is chosen from SEQ ID NO: 30.

Preferred immunoglobulin single variable domains for use in thepolypeptide of the invention include PMP7F4, PMP7C4, PMP7D6, PMP7G7,PMP7G8, 20F6, 20A11, 20E10, 21A10 and 21D11 (SEQ ID NO's: 1-10), moreparticularly 20F6, 20A11, 20E10, 21A10 and 21D11 (SEQ ID NO's: 1, 6, and8-10) of which 20A11 (SEQ ID NO: 1) is particularly preferred.

Polypeptide of the Invention

The immunoglobulin single variable domains for use in the method of theinvention may form part of a protein or polypeptide (referred herein as“polypeptide of the invention”), which may comprise or essentiallyconsist of one or more immunoglobulin single variable domains thatspecifically binds IL-6R and which may optionally further comprise oneor more further amino acid sequences (all optionally linked via one ormore suitable linkers). The term “immunoglobulin single variable domain”may also encompass such polypeptide of the invention. For example, andwithout limitation, the one or more immunoglobulin single variabledomains may be used as a binding unit in such a protein or polypeptide,which may optionally contain one or more further amino acid sequencesthat can serve as a binding unit, so as to provide a monovalent,multivalent or multispecific polypeptide of the invention, respectively(for multivalent and multispecific polypeptides containing one or moreVHH domains and their preparation, reference is also made to Conrath etal. 2001 (J. Biol. Chem. 276: 7346-7350), as well as to for example WO96/34103, WO 99/23221 and WO 2010/115998).

The polypeptides of the invention may encompass constructs comprisingtwo or more antigen binding units in the form of single variabledomains, as outlined above. For example, two (or more) immunoglobulinsingle variable domains with the same or different antigen specificitycan be linked to form e.g. a bivalent, trivalent or multivalentconstruct. By combining immunoglobulin single variable domains of two ormore specificities, bispecific, trispecific etc. constructs can beformed. For example, an immunoglobulin single variable domain accordingto the invention may comprise two or three immunoglobulin singlevariable domains directed against the same target (i.e. IL-6R), or oneor two immunoglobulin single variable domains directed against target A(i.e. IL-6R), and one immunoglobulin single variable domain againsttarget B. Such constructs and modifications thereof, which the skilledperson can readily envisage, are all encompassed by the termimmunoglobulin single variable domain as used herein.

In an aspect of the invention, the polypeptide of the invention thatcomprises or essentially consists of one or more immunoglobulin singlevariable domains (or suitable fragments thereof) that specifically bindIL-6R, may further comprise one or more other groups, residues, moietiesor binding units. Such further groups, residues, moieties, binding unitsor amino acid sequences may or may not provide further functionality tothe immunoglobulin single variable domain (and/or to the polypeptide inwhich it is present) and may or may not modify the properties of theimmunoglobulin single variable domain.

For example, such further groups, residues, moieties or binding unitsmay be one or more additional amino acid sequences, such that thecompound, construct or polypeptide is a (fusion) protein or (fusion)polypeptide. In a preferred but non-limiting aspect, said one or moreother groups, residues, moieties or binding units are immunoglobulinsequences. Even more preferably, said one or more other groups,residues, moieties or binding units are chosen from the group consistingof domain antibodies, amino acid sequences that are suitable for use asa domain antibody, single domain antibodies, amino acid sequences thatare suitable for use as a single domain antibody, “dAb”'s, amino acidsequences that are suitable for use as a dAb, or Nanobodies.

Alternatively, such groups, residues, moieties or binding units may forexample be chemical groups, residues, moieties, which may or may not bythemselves be biologically and/or pharmacologically active. For example,and without limitation, such groups may be linked to the one or moreimmunoglobulin single variable domain so as to provide a “derivative” ofthe immunoglobulin single variable domain.

In the polypeptides described above, the one or more immunoglobulinsingle variable domains and the one or more groups, residues, moietiesor binding units may be linked directly to each other and/or via one ormore suitable linkers or spacers. For example, when the one or moregroups, residues, moieties or binding units are amino acid sequences,the linkers may also be amino acid sequences, so that the resultingpolypeptide is a fusion (protein) or fusion (polypeptide).

Suitable spacers or linkers for use in multivalent and/or multispecificpolypeptides will be clear to the skilled person, and may generally beany linker or spacer used in the art to link amino acid sequences.Preferably, said linker or spacer is suitable for use in constructingproteins or polypeptides that are intended for pharmaceutical use.

Some particularly preferred spacers include the spacers and linkers thatare used in the art to link antibody fragments or antibody domains.These include the linkers mentioned in the general background art citedabove, as well as for example linkers that are used in the art toconstruct diabodies or ScFv fragments (in this respect, however, itshould be noted that, whereas in diabodies and in ScFv fragments, thelinker sequence used should have a length, a degree of flexibility andother properties that allow the pertinent V_(H) and V_(L) domains tocome together to form the complete antigen-binding site, there is noparticular limitation on the length or the flexibility of the linkerused in the polypeptide of the invention, since each amino acid sequenceor Nanobody by itself forms a complete antigen-binding site).

For example, a linker may be a suitable amino acid sequence, and inparticular amino acid sequences of between 1 and 50, preferably between1 and 30, such as between 1 and 20 or between 1 and 10 amino acidresidues. Widely used peptide linkers comprise Gly-Ser repeats, e.g.(Gly)4-Ser in one, two, three, four, five, six or more repeats, or forexample of the type (gly_(x)ser_(y))_(z), such as (for example(gly₄ser)₃ or (gly₃ser₂)₃, as described in WO 99/42077, or hinge-likeregions such as the hinge regions of naturally occurring heavy chainantibodies or similar sequences (such as described in WO 94/04678). Someother particularly preferred linkers are poly-alanine (such as AAA), aswell as the linkers mentioned in Table A-5, of which AAA, GS-7, GS-8 andGS-9 are particularly preferred.

Other suitable linkers generally comprise organic compounds or polymers,in particular those suitable for use in proteins for pharmaceutical use.For instance, poly(ethyleneglycol) moieties have been used to linkantibody domains, see for example WO 04/081026.

In one specific aspect of the invention, a polypeptide of the inventionis prepared that has an increased half-life, compared to thecorresponding immunoglobulin single variable domain. Examples ofpolypeptides of the invention that comprise such half-life extendingmoieties for example include, without limitation, polypeptides in whichthe immunoglobulin single variable domain is suitable linked to one ormore serum proteins or fragments thereof (such as (human) serum albuminor suitable fragments thereof) or to one or more binding units orpeptides that can bind to serum proteins (such as, for example, domainantibodies, amino acid sequences that are suitable for use as a domainantibody, single domain antibodies, amino acid sequences that aresuitable for use as a single domain antibody, “dAb”'s, amino acidsequences that are suitable for use as a dAb, or Nanobodies that canbind to serum proteins such as serum albumin (such as human serumalbumin), serum immunoglobulins such as IgG, or transferrine);polypeptides in which the immunoglobulin single variable domain islinked to an Fc portion (such as a human Fc) or a suitable part orfragment thereof; or polypeptides in which the one or moreimmunoglobulin single variable domains are suitable linked to one ormore small proteins or peptides that can bind to serum proteins (suchas, without limitation, the proteins and peptides described in WO91/01743, WO 01/45746, or WO 02/076489).

Generally, the polypeptides of the invention with increased half-lifepreferably have a half-life that is at least 1.5 times, preferably atleast 2 times, such as at least 5 times, for example at least 10 timesor more than 20 times, greater than the half-life of the correspondingimmunoglobulin single variable domain or polypeptide of the inventionper se.

A preferred polypeptide of the invention comprises one or moreimmunoglobulin single variable domains against IL-6R, e.g. according toSEQ ID NO's: 1-10, in particular SEQ ID NO: 1, in combination with atleast one binding domain or peptide suitable for extending serumhalf-life (preferably T1/2β) of the construct. In these constructs, the“serum-albumin binding domain or peptide” may be any suitableserum-albumin binding peptide or binding domain capable of increasingthe half-life (preferably T1/2β) of the construct (compared to the sameconstruct without the serum-albumin binding peptide or binding domain).Specifically, the polypeptide sequence suitable for extending serumhalf-life is a polypeptide sequence capable of binding to a serumprotein with a long serum half-life, such as serum albumin,transferring, IgG, etc., in particular serum albumin. Polypeptidesequences capable of binding to serum albumin have previously beendescribed and may in particular be serum albumin binding peptides asdescribed in WO 08/068280 by applicant (and in particular WO 09/127691and WO 2011/095545, both by applicant), or a serum albumin bindingimmunoglobulin single variable domains (such as a serum-albumin bindingNanobody; for example Alb-1 or a humanized version of Alb-1 such asAlb-8, for which reference is for example made to WO 06/122787 and TableA-4).

As discussed above, in the polypeptides of the invention the one or moreimmunoglobulin single variable domain binding to IL-6R and the aminoacid sequences or domains suitable for extending serum half-life can befused with or without a linker, e.g. a peptide linker.

In a preferred polypeptide for use in the method of the invention one ormore immunoglobulin single variable domains against IL-6R, e.g.according to SEQ ID NO's: 1-10, in particular SEQ ID NO: 1, is linked toa serum albumin binding immunoglobulin single variable domains, such asfor example Alb-1 or a humanized version of Alb-1 such as Alb-8.Preferred polypeptides of the invention include IL6R304, IL6R305 andIL6R306 (SEQ ID NO's: 34-36), particularly IL6R304 (SEQ ID NO: 34).

The polypeptides of the invention administered in the methods of theinvention, i.e., that specifically bind IL-6R, in some aspects have anapparent K_(D) for binding to IL-6R, as determined by Biacore assay, of1 nM to 1 pM (moles/litre) or less, preferably 500 pM to 1 pM(moles/litre) or less, more preferably 100 pM to 1 pM (moles/litre) orless, or even more preferably about 50 pM to 1 pM or less.

The polypeptides of the invention may be produced by a method comprisingthe following steps:

-   -   a) expressing, in a suitable host cell or host organism or in        another suitable expression system, a nucleic acid or nucleotide        sequence, or a genetic construct encoding the polypeptide of the        invention;    -   optionally followed by:    -   b) isolating and/or purifying the polypeptide of the invention        thus obtained.        The method for producing the polypeptide of the invention may        comprise the steps of:    -   a) cultivating and/or maintaining a host or host cell under        conditions that are such that said host or host cell expresses        and/or produces at least one polypeptide of the invention,    -   optionally followed by:    -   b) isolating and/or purifying the polypeptide of the invention        thus obtained.

According to one preferred, but non-limiting embodiment of theinvention, the polypeptide of the invention is produced in a bacterialcell, in particular a bacterial cell suitable for large scalepharmaceutical production.

According to another preferred, but non-limiting embodiment of theinvention, the polypeptide of the invention is produced in a yeast cell,in particular a yeast cell suitable for large scale pharmaceuticalproduction.

According to yet another preferred, but non-limiting embodiment of theinvention, the polypeptide of the invention is produced in a mammaliancell, in particular in a human cell or in a cell of a human cell line,and more in particular in a human cell or in a cell of a human cell linethat is suitable for large scale pharmaceutical production.

For production on industrial scale, preferred heterologous hosts for the(industrial) production of Nanobodies or Nanobody-containing proteintherapeutics include strains of E. coli, Pichia pastoris, S. cerevisiaethat are suitable for large scale expression/production/fermentation,and in particular for large scale pharmaceuticalexpression/production/fermentation. Suitable examples of such strainswill be clear to the skilled person. Such strains andproduction/expression systems are also made available by companies suchas Biovitrum (Uppsala, Sweden).

Alternatively, mammalian cell lines, in particular Chinese hamster ovary(CHO) cells, can be used for large scaleexpression/production/fermentation, and in particular for large scalepharmaceutical expression/production/fermentation. Again, suchexpression/production systems are also made available by some of thecompanies mentioned above.

Subsequently, the polypeptide of the invention may then be isolated fromthe host cell/host organism and/or from the medium in which said hostcell or host organism was cultivated, using protein isolation and/orpurification techniques known per se, such as (preparative)chromatography and/or electrophoresis techniques, differentialprecipitation techniques, affinity techniques (e.g. using a specific,cleavable amino acid sequence fused with the polypeptide of theinvention) and/or preparative immunological techniques (i.e. usingantibodies against the amino acid sequence to be isolated).

Generally, for pharmaceutical use, the polypeptides of the invention maybe formulated as a pharmaceutical preparation or compositions comprisingat least one polypeptide of the invention and at least onepharmaceutically acceptable carrier, diluent or excipient and/oradjuvant, and optionally one or more further pharmaceutically activepolypeptides and/or compounds. Such a formulation may be in a formsuitable for parenteral administration (such as by intravenous,intramuscular or subcutaneous injection or intravenous infusion).

Generally, the polypeptides of the invention can be formulated andadministered in any suitable manner known per se, for which reference isfor example made to the general background art cited above (and inparticular to WO 04/041862, WO 04/041863, WO 04/041865 and WO 04/041867)as well as to the standard handbooks, such as Remington's PharmaceuticalSciences, 18^(th) Ed., Mack Publishing Company, USA (1990) or Remington,the Science and Practice of Pharmacy, 21th Edition, Lippincott Williamsand Wilkins (2005).

Preparations for parenteral administration may for example be sterilesolutions, suspensions, dispersions or emulsions that are suitable forinfusion or injection. Suitable carriers or diluents for suchpreparations for example include, without limitation, sterile water andaqueous buffers and solutions such as physiological phosphate-bufferedsaline, Ringer's solutions, dextrose solution, and Hank's solution;water oils; glycerol; ethanol; glycols such as propylene glycol or aswell as mineral oils, animal oils and vegetable oils, for example peanutoil, soybean oil, as well as suitable mixtures thereof. Usually, aqueoussolutions or suspensions will be preferred.

The invention, however, also encompasses products obtainable by furtherprocessing of a liquid formulation, such as a frozen, lyophilized orspray dried product. Upon reconstitution, these solid products canbecome liquid formulations as described herein (but are not limitedthereto). In its broadest sense, therefore, the term “formulation”encompasses both liquid and solid formulations. However, solidformulations are understood as derivable from the liquid formulations(e.g. by freezing, freeze-drying or spray-drying), and hence havecharacteristics that are defined by the features specified for liquidformulations herein. The invention does not exclude reconstitution thatleads to a composition that deviates from the original compositionbefore e.g. freeze- or spray drying.

Sterile injectable solutions are prepared by incorporating thepolypeptides of the invention in the required amount in the appropriatesolvent with various of the other ingredients enumerated above, asrequired, followed by filter sterilization. In the case of sterilepowders for the preparation of sterile injectable solutions, thepreferred methods of preparation are vacuum drying and the freeze dryingtechniques, which yield a powder of the active ingredient plus anyadditional desired ingredient present in the previously sterile-filteredsolutions.

Generally, the concentration of the polypeptides of the invention in aliquid composition, such as an injectable or infusible preparation, or alotion, will be from about 0.1-25 wt-%, preferably from about 0.5-10wt-%, although the amounts are not limited to these ranges and may behigher or lower weight percentages depending on the need for higher orlower doses that can be administered in a volume that is suitable.

As demonstrated herein in the working examples, concentrations of 10mg/mL have been used. It is expected that other concentrations havingvalues between these concentrations (and also outside these values,i.e., higher or lower than these values) therefore also can be used. Forexample, concentrations of 0.5, 1, 2, 5, 10, 20, 25, 30, 40, 50, 60, 70,80, 90, 100, 120, 150 mg/mL or more can be used.

To obtain the unexpected prolonged and sustained effects describedherein, the polypeptide of the invention is administered in an amountfrom about 1 mg/kg to about 10 mg/kg. Exemplary dose ranges (inclusiveof the values at the ends of each range) include 3-10 mg/kg, such as 3-9mg/kg, 3-8 mg/kg, 3-7 mg/kg, 3-6 mg/kg, 3-5 mg/kg, 3-4 mg/kg, 4-10mg/kg, 4-9 mg/kg, 4-8 mg/kg, 4-7 mg/kg, 4-6 mg/kg, 4-5 mg/kg, 5-10mg/kg, 5-9 mg/kg, 5-8 mg/kg, 5-7 mg/kg, 5-6 mg/kg, 6-10 mg/kg, 6-9mg/kg, 6-8 mg/kg, 6-7 mg/kg, 7-10 mg/kg, 7-9 mg/kg, 7-8 mg/kg, 8-10mg/kg, 8-9 mg/kg, 9-10 mg/kg. A preferred dose range includes 3-6 mg/kg.Specific doses include doses of about 1, about 2, about 3, about 4,about 5, about 6, about 7, about 8, about 9 or about 10 mg/kg, in which3 mg/kg and 6 mg/kg are preferred doses.

The desired dose may conveniently be presented in a single dose or asdivided doses administered at appropriate intervals, for example, asweekly doses, e.g. 4 weekly doses (Q4W) or 8 weekly doses (Q8W).

In a preferred aspect, the polypeptide of the invention is administeredin an amount from about 3 mg/kg to about 10 mg/kg as a single dose.

In another preferred aspect, the polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 10 mg/kg every 4weeks.

In another preferred aspect, the polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 10 mg/kg every 8weeks.

In another preferred aspect, the polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 6 mg/kg as asingle dose.

In another preferred aspect, the polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 6 mg/kg every 4weeks.

In another preferred aspect, the polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 6 mg/kg every 8weeks.

In another preferred aspect, the polypeptide of the invention isadministered at a dose of about 3 mg/kg as a single dose.

In another preferred aspect, the polypeptide of the invention isadministered at a dose of about 3 mg/kg every 4 weeks.

In another preferred aspect, the polypeptide of the invention isadministered at a dose of about 3 mg/kg every 8 weeks.

In another preferred aspect, the polypeptide of the invention isadministered at a dose of about 6 mg/kg as a single dose.

In another preferred aspect, the polypeptide of the invention isadministered at a dose of about 6 mg/kg every 4 weeks.

In another preferred aspect, the polypeptide of the invention isadministered at a dose of about 6 mg/kg every 8 weeks.

The invention also provides methods for inhibiting IL-6 mediatedsignaling in a subject that include administering to the subject apolypeptide of the invention at lower doses to obtain equivalent effectsin inhibiting IL-6 mediated signaling compared to the agents,compositions, methods and/or dosing schedules that are currently usedand/or known in the art. Therefore, in another aspect of the method ofthe invention, the polypeptide of the invention is administered at adose of about 1-2 mg/kg every 1-2 weeks, such as e. at a dose of about 2mg/kg every 2 weeks or at a dose of about 1 mg/kg every week.

Methods are provided for inhibiting IL-6 mediated signaling in a subjectthat include administering to the subject a polypeptide of the inventionin an amount from about 3 mg/kg to about 10 mg/kg, wherein total sIL-6Rlevels in serum are increased for at least 4 weeks after administration.In some embodiments, the serum level of sIL-6R is increased to andmaintained at at least 400 ng/ml or more, such as at least 450 ng/ml, atleast 500 ng/ml, more preferably at least 550 ng/ml, at least 600 ng/ml,at least 650 ng/ml, or even at least 700 ng/ml or more. In a specificaspect, the levels of IL-6R are increased to and maintained at at least400 ng/ml for up to at least 5 weeks, at least 6 weeks, at least 7weeks, at least 8 weeks, at least 9 weeks, at least 10 weeks, at least11 weeks, or even at least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 10 mg/kg, whereinthe levels of sIL-6R are increased to and maintained at at least 450ng/ml for up to at least 5 weeks, at least 6 weeks, at least 7 weeks, atleast 8 weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks,or even at least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 10 mg/kg, whereinthe levels of sIL-6R are increased to and maintained at at least 500ng/ml for up to at least 5 weeks, at least 6 weeks, at least 7 weeks, atleast 8 weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks,or even at least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 10 mg/kg, whereinthe levels of sIL-6R are increased to and maintained at at least 550ng/ml for up to at least 5 weeks, at least 6 weeks, at least 7 weeks, atleast 8 weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks,or even at least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 10 mg/kg, whereinthe levels of sIL-6R are increased to and maintained at at least 600ng/ml or more for up to at least 5 weeks, at least 6 weeks, at least 7weeks, at least 8 weeks, at least 9 weeks, at least 10 weeks, at least11 weeks, or even at least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 10 mg/kg, whereinthe levels of sIL-6R are increased to and maintained at at least 650ng/ml or more for up to at least 5 weeks, at least 6 weeks, at least 7weeks, at least 8 weeks, at least 9 weeks, at least 10 weeks, at least11 weeks, or even at least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 10 mg/kg, whereinthe levels of sIL-6R are increased to and maintained at at least 700ng/ml or more for up to at least 5 weeks, at least 6 weeks, at least 7weeks, at least 8 weeks, at least 9 weeks, at least 10 weeks, at least11 weeks, or even at least 12 weeks after administration.

In a further aspect, methods are provided for inhibiting IL-6 mediatedsignaling in a subject that include administering to the subject apolypeptide of the invention in an amount from about 3 mg/kg to about 6mg/kg, wherein total sIL-6R levels in serum are increased for at least 4weeks after administration. In some embodiments, the serum level ofsIL-6R is increased to and maintained at at least 400 ng/ml or more,such as at least 450 ng/ml, at least 500 ng/ml, more preferably at least550 ng/ml, at least 600 ng/ml, at least 650 ng/ml, or even at least 700ng/ml or more. In a specific aspect, the levels of sIL-6R are increasedto and maintained at at least 400 ng/ml for up to at least 5 weeks, atleast 6 weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, atleast 10 weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 6 mg/kg, whereinthe levels of sIL-6R are increased to and maintained at at least 450ng/ml for up to at least 5 weeks, at least 6 weeks, at least 7 weeks, atleast 8 weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks,or even at least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 6 mg/kg, whereinthe levels of sIL-6R are increased to and maintained at at least 500ng/ml for up to at least 5 weeks, at least 6 weeks, at least 7 weeks, atleast 8 weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks,or even at least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 6 mg/kg, whereinthe levels of sIL-6R are increased to and maintained at at least 550ng/ml for up to at least 5 weeks, at least 6 weeks, at least 7 weeks, atleast 8 weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks,or even at least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 6 mg/kg, whereinthe levels of sIL-6R are increased to and maintained at at least 600ng/ml or more for up to at least 5 weeks, at least 6 weeks, at least 7weeks, at least 8 weeks, at least 9 weeks, at least 10 weeks, at least11 weeks, or even at least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 6 mg/kg, whereinthe levels of sIL-6R are increased to and maintained at at least 650ng/ml or more for up to at least 5 weeks, at least 6 weeks, at least 7weeks, at least 8 weeks, at least 9 weeks, at least 10 weeks, at least11 weeks, or even at least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 6 mg/kg, whereinthe levels of sIL-6R are increased to and maintained at at least 700ng/ml or more for up to at least 5 weeks, at least 6 weeks, at least 7weeks, at least 8 weeks, at least 9 weeks, at least 10 weeks, at least11 weeks, or even at least 12 weeks after administration.

In yet another aspect, methods are provided for inhibiting IL-6 mediatedsignaling in a subject that include administering to the subject apolypeptide of the invention in an amount of about 3 mg/kg, whereintotal sIL-6R levels in serum are increased for at least 4 weeks afteradministration. In some embodiments, the serum level of sIL-6R isincreased to and maintained at at least 400 ng/ml or more, such as atleast 450 ng/ml, at least 500 ng/ml, more preferably at least 550 ng/ml,at least 600 ng/ml, at least 650 ng/ml, or even at least 700 ng/ml ormore. In a specific aspect, the levels of sIL-6R are increased to andmaintained at at least 400 ng/ml for up to at least 5 weeks, at least 6weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, at least 10weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 3 mg/kg, wherein the levels of sIL-6Rare increased to and maintained at at least 450 ng/ml for up to at least5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least9 weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 3 mg/kg, wherein the levels of sIL-6Rare increased to and maintained at at least 500 ng/ml for up to at least5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least9 weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 3 mg/kg, wherein the levels of sIL-6Rare increased to and maintained at at least 550 ng/ml for up to at least5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least9 weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 3 mg/kg, wherein the levels of sIL-6Rare increased to and maintained at at least 600 ng/ml or more for up toat least 5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks,at least 9 weeks, at least 10 weeks, at least 11 weeks, or even at least12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 3 mg/kg, wherein the levels of sIL-6Rare increased to and maintained at at least 650 ng/ml or more for up toat least 5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks,at least 9 weeks, at least 10 weeks, at least 11 weeks, or even at least12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 3 mg/kg, wherein the levels of sIL-6Rare increased to and maintained at at least 700 ng/ml or more for up toat least 5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks,at least 9 weeks, at least 10 weeks, at least 11 weeks, or even at least12 weeks after administration.

In yet another aspect, methods are provided for inhibiting IL-6 mediatedsignaling in a subject that include administering to the subject apolypeptide of the invention in an amount of about 6 mg/kg, whereintotal sIL-6R levels in serum are increased for at least 4 weeks afteradministration. In some embodiments, the serum level of sIL-6R isincreased to and maintained at at least 400 ng/ml or more, such as atleast 450 ng/ml, at least 500 ng/ml, more preferably at least 550 ng/ml,at least 600 ng/ml, at least 650 ng/ml, or even at least 700 ng/ml ormore. In a specific aspect, the levels of sIL-6R are increased to andmaintained at at least 400 ng/ml for up to at least 5 weeks, at least 6weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, at least 10weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 6 mg/kg, wherein the levels of sIL-6Rare increased to and maintained at at least 450 ng/ml for up to at least5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least9 weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 6 mg/kg, wherein the levels of sIL-6Rare increased to and maintained at at least 500 ng/ml for up to at least5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least9 weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 6 mg/kg, wherein the levels of sIL-6Rare increased to and maintained at at least 550 ng/ml for up to at least5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least9 weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 6 mg/kg, wherein the levels of sIL-6Rare increased to and maintained at at least 600 ng/ml or more for up toat least 5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks,at least 9 weeks, at least 10 weeks, at least 11 weeks, or even at least12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 6 mg/kg, wherein the levels of sIL-6Rare increased to and maintained at at least 650 ng/ml or more for up toat least 5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks,at least 9 weeks, at least 10 weeks, at least 11 weeks, or even at least12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 6 mg/kg, wherein the levels of sIL-6Rare increased to and maintained at at least 700 ng/ml or more for up toat least 5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks,at least 9 weeks, at least 10 weeks, at least 11 weeks, or even at least12 weeks after administration.

A preferred dosage schedule includes 3 mg/kg of polypeptide of theinvention every 4 weeks, wherein the levels of sIL-6R are increased toand maintained at at least 400 ng/ml or more, such as at least 450ng/ml, at least 500 ng/ml, more preferably at least 550 ng/ml, at least600 ng/ml, at least 650 ng/ml, or even at least 700 ng/ml or more(during the treatment period).

Another preferred dosage schedule includes 6 mg/kg every 4 weeks,wherein the levels of sIL-6R are increased to and maintained at at least400 ng/ml or more, such as at least 450 ng/ml, at least 500 ng/ml, morepreferably at least 550 ng/ml, at least 600 ng/ml, at least 650 ng/ml,or even at least 700 ng/ml or more (during the treatment period).

Another preferred dosage schedule includes 6 mg/kg every 8 weeks,wherein the levels of sIL-6R are increased to and maintained at at least400 ng/ml or more, such as at least 450 ng/ml, at least 500 ng/ml, morepreferably at least 550 ng/ml, at least 600 ng/ml, at least 650 ng/ml,or even at least 700 ng/ml or more (during the treatment period).

In a preferred aspect, the polypeptide of the invention is SEQ ID NO:34.

Accordingly, the present invention relates a method for inhibiting IL-6mediated signaling in a subject, said method comprising administering tothe subject a polypeptide with SEQ ID NO: 34 in an amount of about 3mg/kg of SEQ ID NO: 34 every 4 weeks, wherein total sIL-6R levels inserum are increased to and maintained (throughout the treatment period)at at least 400 ng/ml. The invention thus also relates to a polypeptidewith SEQ ID NO: 34 for inhibiting IL-6 mediated signaling, wherein thepolypeptide is administered in an amount of 3 mg/kg of polypeptide withSEQ ID NO: 34 every 4 weeks and wherein total sIL-6R levels in serum areincreased to and maintained (throughout the treatment period) at atleast 400 ng/ml. The invention also relates to a polypeptide with SEQ IDNO: 34 for treatment of diseases and/or disorders associated with IL-6mediated signaling, wherein the polypeptide is administered in an amountof 3 mg/kg of polypeptide with SEQ ID NO: 34 every 4 weeks and whereintotal sIL-6R levels in serum are increased to and maintained (throughoutthe treatment period) at at least 400 ng/ml.

In a preferred aspect, the levels of sIL-6R are increased to andmaintained at at least 400 ng/ml or more, such as at least 450 ng/ml, atleast 500 ng/ml, more preferably at least 550 ng/ml, at least 600 ng/ml,at least 650 ng/ml, or even at least 700 ng/ml, or more (during thetreatment period).

The present invention also relates a method for inhibiting IL-6 mediatedsignaling in a subject, said method comprising administering to thesubject a polypeptide with SEQ ID NO: 34 in an amount of about 6 mg/kgof SEQ ID NO: 34 every 4 weeks, wherein total sIL-6R levels in serum areincreased to and maintained (throughout the treatment period) at atleast 400 ng/ml. The invention thus also relates to a polypeptide withSEQ ID NO: 34 for inhibiting IL-6 mediated signaling, wherein thepolypeptide is administered in an amount of 6 mg/kg of polypeptide withSEQ ID NO: 34 every 4 weeks and wherein total sIL-6R levels in serum areincreased to and maintained (throughout the treatment period) at atleast 400 ng/ml. The invention also relates to a polypeptide with SEQ IDNO: 34 for treatment of diseases and/or disorders associated with IL-6mediated signaling, wherein the polypeptide is administered in an amountof 6 mg/kg of polypeptide with SEQ ID NO: 34 every 4 weeks and whereintotal sIL-6R levels in serum are increased to and maintained (throughoutthe treatment period) at at least 400 ng/ml.

In a preferred aspect, the levels of sIL-6R are increased to andmaintained at at least 400 ng/ml or more, such as at least 450 ng/ml, atleast 500 ng/ml, more preferably at least 550 ng/ml, at least 600 ng/ml,at least 650 ng/ml, or even at least 700 ng/ml, or more (during thetreatment period).

In a preferred aspect, a polypeptide with SEQ ID NO: 34 is administeredin an amount of about 100 nmol/kg to about 150 nmol/kg of SEQ ID NO: 34every 4 weeks and total sIL-6R levels in serum are increased to andmaintained (throughout the treatment period) at at least 500 ng/ml.

In another preferred aspect, a polypeptide with SEQ ID NO: 34 isadministered in an amount of about 100 nmol/kg to about 150 nmol/kg ofSEQ ID NO: 34 every 4 weeks and total sIL-6R levels in serum areincreased to and maintained (throughout the treatment period) at atleast 550 ng/ml.

In yet another preferred aspect, a polypeptide with SEQ ID NO: 34 isadministered in an amount of about 100 nmol/kg to about 150 nmol/kg ofSEQ ID NO: 34 every 4 weeks and total sIL-6R levels in serum areincreased to and maintained (throughout the treatment period) at atleast 600 ng/ml.

In yet another preferred aspect, a polypeptide with SEQ ID NO: 34 isadministered in an amount of about 100 nmol/kg to about 120 nmol/kg ofSEQ ID NO: 34 every 4 weeks and total sIL-6R levels in serum areincreased to and maintained (throughout the treatment period) at atleast 500 ng/ml.

In yet another preferred aspect, a polypeptide with SEQ ID NO: 34 isadministered in an amount of about 100 nmol/kg to about 120 nmol/kg ofSEQ ID NO: 34 every 4 weeks and total sIL-6R levels in serum areincreased to and maintained (throughout the treatment period) at atleast 550 ng/ml.

In yet another preferred aspect, a polypeptide with SEQ ID NO: 34 isadministered in an amount of about 100 nmol/kg to about 120 nmol/kg ofSEQ ID NO: 34 every 4 weeks and total sIL-6R levels in serum areincreased to and maintained (throughout the treatment period) at atleast 600 ng/ml.

The present invention also relates a method for inhibiting IL-6 mediatedsignaling in a subject, said method comprising administering to thesubject a polypeptide with SEQ ID NO: 34 in an amount of about 6 mg/kgof SEQ ID NO: 34 every 8 weeks, wherein total sIL-6R levels in serum areincreased to and maintained (throughout the treatment period) at atleast 400 ng/ml. The invention thus also relates to a polypeptide withSEQ ID NO: 34 for inhibiting IL-6 mediated signaling, wherein thepolypeptide is administered in an amount of 6 mg/kg of polypeptide withSEQ ID NO: 34 every 8 weeks and wherein total sIL-6R levels in serum areincreased to and maintained (throughout the treatment period) at atleast 400 ng/ml. The invention also relates to a polypeptide with SEQ IDNO: 34 for treatment of diseases and/or disorders associated with IL-6mediated signaling, wherein the polypeptide is administered in an amountof 6 mg/kg of polypeptide with SEQ ID NO: 34 every 8 weeks and whereintotal sIL-6R levels in serum are increased to and maintained (throughoutthe treatment period) at at least 400 ng/ml.

In a preferred aspect, the levels of sIL-6R are increased to andmaintained at at least 400 ng/ml or more, such as at least 450 ng/ml, atleast 500 ng/ml, more preferably at least 550 ng/ml, at least 600 ng/ml,at least 650 ng/ml, or even at least 700 ng/ml or more (during thetreatment period).

Methods are provided for inhibiting IL-6 mediated signaling in a subjectthat include administering to the subject a polypeptide of the inventionin an amount from about 3 mg/kg to about 10 mg/kg, wherein total IL-6levels in serum are increased for at least 4 weeks after administration.In some embodiments, the serum level of IL-6 are increased to andmaintained at at least 40 pg/ml or more, such as at least 45 pg/ml, atleast 50 pg/ml, more preferably at least 55 pg/ml or even at least 60pg/ml or more. In a specific aspect, the levels of IL-6 are increased toand maintained at at least 40 pg/ml for up to at least 5 weeks, at least6 weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, at least10 weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 10 mg/kg, whereinthe levels of IL-6 are increased to and maintained at at least 45 pg/mlfor up to at least 5 weeks, at least 6 weeks, at least 7 weeks, at least8 weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks, or evenat least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 10 mg/kg, whereinthe levels of IL-6 are increased to and maintained at at least 50 pg/mlfor up to at least 5 weeks, at least 6 weeks, at least 7 weeks, at least8 weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks, or evenat least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 10 mg/kg, whereinthe levels of IL-6 are increased to and maintained at at least 55 pg/mlfor up to at least 5 weeks, at least 6 weeks, at least 7 weeks, at least8 weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks, or evenat least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 10 mg/kg, whereinthe levels of IL-6 are increased to and maintained at at least 60 pg/mlor more for up to at least 5 weeks, at least 6 weeks, at least 7 weeks,at least 8 weeks, at least 9 weeks, at least 10 weeks, at least 11weeks, or even at least 12 weeks after administration.

In a further aspect, methods are provided for inhibiting IL-6 mediatedsignaling in a subject that include administering to the subject apolypeptide of the invention in an amount from about 3 mg/kg to about 6mg/kg, wherein total IL-6 levels in serum are increased for at least 4weeks after administration. In some embodiments, the serum level of IL-6is increased to and maintained at at least 40 pg/ml or more, such as atleast 45 pg/ml, at least 50 pg/ml, more preferably at least 55 pg/ml oreven at least 60 pg/ml or more. In a specific aspect, the levels of IL-6are increased to and maintained at at least 40 pg/ml for up to at least5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least9 weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 6 mg/kg, whereinthe levels of IL-6 are increased to and maintained at at least 45 pg/mlfor up to at least 5 weeks, at least 6 weeks, at least 7 weeks, at least8 weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks, or evenat least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 6 mg/kg, whereinthe levels of IL-6 are increased to and maintained at at least 50 pg/mlfor up to at least 5 weeks, at least 6 weeks, at least 7 weeks, at least8 weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks, or evenat least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 6 mg/kg, whereinthe levels of IL-6 are increased to and maintained at at least 55 pg/mlfor up to at least 5 weeks, at least 6 weeks, at least 7 weeks, at least8 weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks, or evenat least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 6 mg/kg, whereinthe levels of IL-6 are increased to and maintained at at least 60 pg/mlor more for up to at least 5 weeks, at least 6 weeks, at least 7 weeks,at least 8 weeks, at least 9 weeks, at least 10 weeks, at least 11weeks, or even at least 12 weeks after administration.

In yet another aspect, methods are provided for inhibiting IL-6 mediatedsignaling in a subject that include administering to the subject apolypeptide of the invention in an amount of about 3 mg/kg, whereintotal IL-6 levels in serum are increased for at least 4 weeks afteradministration. In some embodiments, the serum level of IL-6 isincreased to and maintained at at least 40 pg/ml or more, such as atleast 45 pg/ml, at least 50 pg/ml, more preferably at least 55 pg/ml oreven at least 60 pg/ml or more. In a specific aspect, the levels of IL-6are increased to and maintained at at least 40 pg/ml for up to at least5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least9 weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 3 mg/kg, wherein the levels of IL-6are increased to and maintained at at least 45 pg/ml for up to at least5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least9 weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 3 mg/kg, wherein the levels of IL-6are increased to and maintained at at least 50 pg/ml for up to at least5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least9 weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 3 mg/kg, wherein the levels of IL-6are increased to and maintained at at least 55 pg/ml for up to at least5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least9 weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 3 mg/kg, wherein the levels of IL-6are increased to and maintained at at least 60 pg/ml or more for up toat least 5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks,at least 9 weeks, at least 10 weeks, at least 11 weeks, or even at least12 weeks after administration.

In yet another aspect, methods are provided for inhibiting IL-6 mediatedsignaling in a subject that include administering to the subject apolypeptide of the invention in an amount of about 6 mg/kg, whereintotal IL-6 levels in serum are increased for at least 4 weeks afteradministration. In some embodiments, the serum level of IL-6 isincreased to and maintained at at least 40 pg/ml or more, such as atleast 45 pg/ml, at least 50 pg/ml, more preferably at least 55 pg/ml oreven at least 60 pg/ml or more. In a specific aspect, the levels of IL-6are increased to and maintained at at least 40 pg/ml for up to at least5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least9 weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 6 mg/kg, wherein the levels of IL-6are increased to and maintained at at least 45 pg/ml for up to at least5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least9 weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 6 mg/kg, wherein the levels of IL-6are increased to and maintained at at least 50 pg/ml for up to at least5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least9 weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 6 mg/kg, wherein the levels of IL-6are increased to and maintained at at least 55 pg/ml for up to at least5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least9 weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 6 mg/kg, wherein the levels of IL-6are increased to and maintained at at least 60 pg/ml or more for up toat least 5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks,at least 9 weeks, at least 10 weeks, at least 11 weeks, or even at least12 weeks after administration.

A preferred dosage schedule includes 3 mg/kg of polypeptide of theinvention every 4 weeks, wherein the levels of IL-6 are increased to andmaintained at at least 40 pg/ml or more, such as at least 45 pg/ml, atleast 50 pg/ml, more preferably at least 55 pg/ml or even at least 60pg/ml or more (during the treatment period).

Another preferred dosage schedule includes 6 mg/kg of polypeptide of theinvention every 4 weeks, wherein the levels of IL-6 are increased to andmaintained at at least 40 pg/ml or more, such as at least 45 pg/ml, atleast 50 pg/ml, more preferably at least 55 pg/ml or even at least 60pg/ml or more (during the treatment period).

Another preferred dosage schedule includes 6 mg/kg of polypeptide of theinvention every 8 weeks, wherein the levels of IL-6 are increased to andmaintained at at least 40 pg/ml or more, such as at least 45 pg/ml, atleast 50 pg/ml, more preferably at least 55 pg/ml or even at least 60pg/ml or more (during the treatment period).

In a preferred aspect, the polypeptide of the invention is SEQ ID NO:34.

Accordingly, the invention relates to a method for inhibiting IL-6mediated signaling in a subject, said method comprising administering tothe subject a polypeptide with SEQ ID NO: 34 in an amount of 3 mg/kg ofpolypeptide with SEQ ID NO: 34 every 4 weeks, wherein total sIL-6Rlevels in serum are increased to and maintained (throughout thetreatment period) at at least 40 pg/ml. The invention thus also relatesto a polypeptide with SEQ ID NO: 34 for inhibiting IL-6 mediatedsignaling, wherein the polypeptide is administered in an amount of 3mg/kg of polypeptide with SEQ ID NO: 34 every 4 weeks and wherein totalsIL-6R levels in serum are increased to and maintained (throughout thetreatment period) at at least 40 pg/ml. The invention also relates to apolypeptide with SEQ ID NO: 34 for treatment of diseases and/ordisorders associated with IL-6 mediated signaling, wherein thepolypeptide is administered in an amount of 3 mg/kg of polypeptide withSEQ ID NO: 34 every 4 weeks and wherein total sIL-6R levels in serum areincreased to and maintained (throughout the treatment period) at atleast 40 pg/ml.

In a preferred aspect the levels of IL-6 are increased to and maintainedat at least 40 pg/ml or more, such as at least 45 pg/ml, at least 50pg/ml, more preferably at least 55 pg/ml or even at least 60 pg/ml ormore (during the treatment period).

The invention also relates to a method for inhibiting IL-6 mediatedsignaling in a subject, said method comprising administering to thesubject a polypeptide with SEQ ID NO: 34 in an amount of 6 mg/kg ofpolypeptide with SEQ ID NO: 34 every 4 weeks, wherein total sIL-6Rlevels in serum are increased to and maintained (throughout thetreatment period) at at least 40 pg/ml. The invention thus also relatesto a polypeptide with SEQ ID NO: 34 for inhibiting IL-6 mediatedsignaling, wherein the polypeptide is administered in an amount of 6mg/kg of polypeptide with SEQ ID NO: 34 every 4 weeks and wherein totalsIL-6R levels in serum are increased to and maintained (throughout thetreatment period) at at least 40 pg/ml. The invention also relates to apolypeptide with SEQ ID NO: 34 for treatment of diseases and/ordisorders associated with IL-6 mediated signaling, wherein thepolypeptide is administered in an amount of 6 mg/kg of polypeptide withSEQ ID NO: 34 every 4 weeks and wherein total sIL-6R levels in serum areincreased to and maintained (throughout the treatment period) at atleast 40 pg/ml.

In a preferred aspect the levels of IL-6 are increased to and maintainedat at least 40 pg/ml or more, such as at least 45 pg/ml, at least 50pg/ml, more preferably at least 55 pg/ml or even at least 60 pg/ml ormore (during the treatment period).

The invention also relates to a method for inhibiting IL-6 mediatedsignaling in a subject, said method comprising administering to thesubject a polypeptide with SEQ ID NO: 34 in an amount of 6 mg/kg ofpolypeptide with SEQ ID NO: 34 every 8 weeks, wherein total sIL-6Rlevels in serum are increased to and maintained (throughout thetreatment period) at at least 40 pg/ml. The invention thus also relatesto a polypeptide with SEQ ID NO: 34 for inhibiting IL-6 mediatedsignaling, wherein the polypeptide is administered in an amount of 6mg/kg of polypeptide with SEQ ID NO: 34 every 8 weeks and wherein totalsIL-6R levels in serum are increased to and maintained (throughout thetreatment period) at at least 40 pg/ml. The invention also relates to apolypeptide with SEQ ID NO: 34 for treatment of diseases and/ordisorders associated with IL-6 mediated signaling, wherein thepolypeptide is administered in an amount of 6 mg/kg of polypeptide withSEQ ID NO: 34 every 8 weeks and wherein total sIL-6R levels in serum areincreased to and maintained (throughout the treatment period) at atleast 40 pg/ml.

In a preferred aspect the levels of IL-6 are increased to and maintainedat at least 40 pg/ml or more, such as at least 45 pg/ml, at least 50pg/ml, more preferably at least 55 pg/ml or even at least 60 pg/ml ormore (during the treatment period).

Methods are provided for inhibiting IL-6 mediated signaling in a subjectthat include administering to the subject a polypeptide of the inventionin an amount from about 3 mg/kg to about 10 mg/kg, wherein CRP levels inserum are decreased for at least 4 weeks after administration. In someembodiments, the serum level of CRP is decreased to and maintained below10 mg/l or less, such as below 9 mg/l or below 8 mg/l, more preferablybelow 7.5 mg/l, below 7 mg/l or below 6.5 mg/l, or even below 6 mg/l,below 5.5 mg/l, below 5 mg/l, or less. In a specific aspect, the levelsof CRP are decreased to and maintained below 10 mg/l for up to at least5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least9 weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 10 mg/kg, whereinthe levels of CRP are decreased to and maintained below 9 mg/l for up toat least 5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks,at least 9 weeks, at least 10 weeks, at least 11 weeks, or even at least12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 10 mg/kg, whereinthe levels of CRP are decreased to and maintained below 8 mg/l for up toat least 5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks,at least 9 weeks, at least 10 weeks, at least 11 weeks, or even at least12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 10 mg/kg, whereinthe levels of CRP are decreased to and maintained below 7.5 mg/l for upto at least 5 weeks, at least 6 weeks, at least 7 weeks, at least 8weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks, or evenat least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 10 mg/kg, whereinthe levels of CRP are decreased to and maintained below 7 mg/l for up toat least 5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks,at least 9 weeks, at least 10 weeks, at least 11 weeks, or even at least12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 10 mg/kg, whereinthe levels of CRP are decreased to and maintained below 6.5 mg/l for upto at least 5 weeks, at least 6 weeks, at least 7 weeks, at least 8weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks, or evenat least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 10 mg/kg, whereinthe levels of CRP are decreased to and maintained below 6 mg/l for up toat least 5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks,at least 9 weeks, at least 10 weeks, at least 11 weeks, or even at least12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 10 mg/kg, whereinthe levels of CRP are decreased to and maintained below 5.5 mg/l for upto at least 5 weeks, at least 6 weeks, at least 7 weeks, at least 8weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks, or evenat least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 10 mg/kg, whereinthe levels of CRP are decreased to and maintained below 5 mg/l or lessfor up to at least 5 weeks, at least 6 weeks, at least 7 weeks, at least8 weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks, or evenat least 12 weeks after administration. In a further aspect, methods areprovided for inhibiting IL-6 mediated signaling in a subject thatinclude administering to the subject a polypeptide of the invention inan amount from about 3 mg/kg to about 6 mg/kg, wherein CRP levels inserum are decreased for at least 4 weeks after administration. In someembodiments, the serum level of CRP is decreased to and maintained below10 mg/l or less, such as below 9 mg/l or below 8 mg/l, more preferablybelow 7.5 mg/l, below 7 mg/l or below 6.5 mg/l, or even below 6 mg/l,below 5.5 mg/l, below 5 mg/l, or less. In a specific aspect, the levelsof CRP are decreased to and maintained below 10 mg/l for up to at least5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least9 weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 6 mg/kg, whereinthe levels of CRP are decreased to and maintained below 9 mg/l for up toat least 5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks,at least 9 weeks, at least 10 weeks, at least 11 weeks, or even at least12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 6 mg/kg, whereinthe levels of CRP are decreased to and maintained below 8 mg/l for up toat least 5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks,at least 9 weeks, at least 10 weeks, at least 11 weeks, or even at least12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 6 mg/kg, whereinthe levels of CRP are decreased to and maintained below 7.5 mg/l for upto at least 5 weeks, at least 6 weeks, at least 7 weeks, at least 8weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks, or evenat least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 6 mg/kg, whereinthe levels of CRP are decreased to and maintained below 7 mg/l for up toat least 5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks,at least 9 weeks, at least 10 weeks, at least 11 weeks, or even at least12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 6 mg/kg, whereinthe levels of CRP are decreased to and maintained below 6.5 mg/l for upto at least 5 weeks, at least 6 weeks, at least 7 weeks, at least 8weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks, or evenat least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 6 mg/kg, whereinthe levels of CRP are decreased to and maintained below 6 mg/l for up toat least 5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks,at least 9 weeks, at least 10 weeks, at least 11 weeks, or even at least12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 6 mg/kg, whereinthe levels of CRP are decreased to and maintained below 5.5 mg/l for upto at least 5 weeks, at least 6 weeks, at least 7 weeks, at least 8weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks, or evenat least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 6 mg/kg, whereinthe levels of CRP are decreased to and maintained below 5 mg/l or lessfor up to at least 5 weeks, at least 6 weeks, at least 7 weeks, at least8 weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks, or evenat least 12 weeks after administration.

Methods are provided for inhibiting IL-6 mediated signaling in a subjectthat include administering to the subject a polypeptide of the inventionin an amount of about 3 mg/kg, wherein CRP levels in serum are decreasedfor at least 4 weeks after administration. In some embodiments, theserum level of CRP is decreased to and maintained below 10 mg/l or less,such as below 9 mg/l or below 8 mg/l, more preferably below 7.5 mg/l,below 7 mg/l or below 6.5 mg/l, or even below 6 mg/l, below 5.5 mg/l,below 5 mg/l, or less. In a specific aspect, the levels of CRP aredecreased to and maintained below 10 mg/l for up to at least 5 weeks, atleast 6 weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, atleast 10 weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 3 mg/kg, wherein the levels of CRPare decreased to and maintained below 9 mg/l for up to at least 5 weeks,at least 6 weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks,at least 10 weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 3 mg/kg, wherein the levels of CRPare decreased to and maintained below 8 mg/l for up to at least 5 weeks,at least 6 weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks,at least 10 weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 3 mg/kg, wherein the levels of CRPare decreased to and maintained below 7.5 mg/l for up to at least 5weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least 9weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 3 mg/kg, wherein the levels of CRPare decreased to and maintained below 7 mg/l for up to at least 5 weeks,at least 6 weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks,at least 10 weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 3 mg/kg, wherein the levels of CRPare decreased to and maintained below 6.5 mg/l for up to at least 5weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least 9weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 3 mg/kg, wherein the levels of CRPare decreased to and maintained below 6 mg/l for up to at least 5 weeks,at least 6 weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks,at least 10 weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 3 mg/kg, wherein the levels of CRPare decreased to and maintained below 5.5 mg/l for up to at least 5weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least 9weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 3 mg/kg, wherein the levels of CRPare decreased to and maintained below 5 mg/l or less for up to at least5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least9 weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

Methods are provided for inhibiting IL-6 mediated signaling in a subjectthat include administering to the subject a polypeptide of the inventionin an amount of about 6 mg/kg, wherein CRP levels in serum are decreasedfor at least 4 weeks after administration. In some embodiments, theserum level of CRP is decreased to and maintained below 10 mg/l or less,such as below 9 mg/l or below 8 mg/l, more preferably below 7.5 mg/l,below 7 mg/l or below 6.5 mg/l, or even below 6 mg/l, below 5.5 mg/l,below 5 mg/l, or less. In a specific aspect, the levels of CRP aredecreased to and maintained below 10 mg/l for up to at least 5 weeks, atleast 6 weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, atleast 10 weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 6 mg/kg, wherein the levels of CRPare decreased to and maintained below 9 mg/l for up to at least 5 weeks,at least 6 weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks,at least 10 weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, a polypeptide of the invention isadministered in in an amount of about 6 mg/kg, wherein the levels of CRPare decreased to and maintained below 8 mg/l for up to at least 5 weeks,at least 6 weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks,at least 10 weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 6 mg/kg, wherein the levels of CRPare decreased to and maintained below 7.5 mg/l for up to at least 5weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least 9weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 6 mg/kg, wherein the levels of CRPare decreased to and maintained below 7 mg/l for up to at least 5 weeks,at least 6 weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks,at least 10 weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 6 mg/kg, wherein the levels of CRPare decreased to and maintained below 6.5 mg/l for up to at least 5weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least 9weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 6 mg/kg, wherein the levels of CRPare decreased to and maintained below 6 mg/l for up to at least 5 weeks,at least 6 weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks,at least 10 weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 6 mg/kg, wherein the levels of CRPare decreased to and maintained below 5.5 mg/l for up to at least 5weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least 9weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 6 mg/kg, wherein the levels of CRPare decreased to and maintained below 5 mg/l or less for up to at least5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least9 weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

A preferred dosage schedule includes 3 mg/kg of polypeptide of theinvention every 4 weeks, wherein the levels of CRP are decreased to andmaintained below 10 mg/ml or less, such as below 9 mg/l or below 8 mg/l,more preferably below 7.5 mg/l, below 7 mg/l or below 6.5 mg/l, or evenbelow 6 mg/l, below 5.5 mg/l, below 5 mg/l, or less (during thetreatment period).

Another preferred dosage schedule includes 6 mg/kg of polypeptide of theinvention every 4 weeks, wherein the levels of CRP are decreased to andmaintained below 10 mg/ml or less, such as below 9 mg/l or below 8 mg/l,more preferably below 7.5 mg/l, below 7 mg/l or below 6.5 mg/l, or evenbelow 6 mg/l, below 5.5 mg/l, below 5 mg/l, or less (during thetreatment period).

Another preferred dosage schedule includes 6 mg/kg of polypeptide of theinvention every 8 weeks, wherein the levels of CRP are decreased to andmaintained below 10 mg/ml or less, such as below 9 mg/l or below 8 mg/l,more preferably below 7.5 mg/l, below 7 mg/l or below 6.5 mg/l, or evenbelow 6 mg/l, below 5.5 mg/l, below 5 mg/l, or less (during thetreatment period).

In a preferred aspect, the polypeptide of the invention is SEQ ID NO:34.

Accordingly, the present invention relates to a method for inhibitingIL-6 mediated signaling in a subject, said method comprisingadministering to the subject a polypeptide with SEQ ID NO: 34 in anamount of 3 mg/kg of polypeptide with SEQ ID NO: 34 every 4 weeks,wherein CRP levels in serum are decreased to and maintained below 10mg/l. The invention thus also relates to a polypeptide with SEQ ID NO:34 for inhibiting IL-6 mediated signaling, wherein the polypeptide isadministered in an amount of 3 mg/kg of polypeptide with SEQ ID NO: 34every 4 weeks and wherein CRP levels in serum are decreased to andmaintained below 10 mg/l. The invention also relates to a polypeptidewith SEQ ID NO: 34 for treatment of diseases and/or disorders associatedwith IL-6 mediated signaling, wherein the polypeptide is administered inan amount of 3 mg/kg of polypeptide with SEQ ID NO: 34 every 4 weeks andwherein CRP levels in serum are decreased to and maintained below 10mg/l.

In a preferred aspect, the levels of CRP are decreased to and maintainedbelow 10 mg/ml or less, such as below 9 mg/l or below 8 mg/l, morepreferably below 7.5 mg/l, below 7 mg/l or below 6.5 mg/l, or even below6 mg/l, below 5.5 mg/l, below 5 mg/l, or less (during the treatmentperiod).

The present invention also relates to a method for inhibiting IL-6mediated signaling in a subject, said method comprising administering tothe subject a polypeptide with SEQ ID NO: 34 in an amount of 6 mg/kg ofpolypeptide with SEQ ID NO: 34 every 4 weeks, wherein CRP levels inserum are decreased to and maintained below 10 mg/l. The invention thusalso relates to a polypeptide with SEQ ID NO: 34 for inhibiting IL-6mediated signaling, wherein the polypeptide is administered in an amountof 6 mg/kg of polypeptide with SEQ ID NO: 34 every 4 weeks and whereinCRP levels in serum are decreased to and maintained below 10 mg/l. Theinvention also relates to a polypeptide with SEQ ID NO: 34 for treatmentof diseases and/or disorders associated with IL-6 mediated signaling,wherein the polypeptide is administered in an amount of 6 mg/kg ofpolypeptide with SEQ ID NO: 34 every 4 weeks and wherein CRP levels inserum are decreased to and maintained below 10 mg/l.

In a preferred aspect, the levels of CRP are decreased to and maintainedbelow 10 mg/ml or less, such as below 9 mg/l or below 8 mg/l, morepreferably below 7.5 mg/l, below 7 mg/l or below 6.5 mg/l, or even below6 mg/l, below 5.5 mg/l, below 5 mg/l, or less (during the treatmentperiod).

The present invention also relates to a method for inhibiting IL-6mediated signaling in a subject, said method comprising administering tothe subject a polypeptide with SEQ ID NO: 34 in an amount of 6 mg/kg ofpolypeptide with SEQ ID NO: 34 every 8 weeks, wherein CRP levels inserum are decreased to and maintained below 10 mg/l. The invention thusalso relates to a polypeptide with SEQ ID NO: 34 for inhibiting IL-6mediated signaling, wherein the polypeptide is administered in an amountof 6 mg/kg of polypeptide with SEQ ID NO: 34 every 8 weeks and whereinCRP levels in serum are decreased to and maintained below 10 mg/l. Theinvention also relates to a polypeptide with SEQ ID NO: 34 for treatmentof diseases and/or disorders associated with IL-6 mediated signaling,wherein the polypeptide is administered in an amount of 6 mg/kg ofpolypeptide with SEQ ID NO: 34 every 8 weeks and wherein CRP levels inserum are decreased to and maintained below 10 mg/l.

In a preferred aspect, the levels of CRP are decreased to and maintainedbelow 10 mg/ml or less, such as below 9 mg/l or below 8 mg/l, morepreferably below 7.5 mg/l, below 7 mg/l or below 6.5 mg/l, or even below6 mg/l, below 5.5 mg/l, below 5 mg/l, or less (during the treatmentperiod).

In a specific aspect, when the subject is also receiving methotrexate(MTX) therapy, the baseline CRP levels (i.e. the CRP levels beforedosing the polypeptide of the invention) in serum are most likelyalready below 10 mg/ml or less (unrelated to the anti-IL-6R therapy).Accordingly, “reduction of CRP levels in serum below 10 mg/l or less andmaintenance of CRP levels in serum below 10 mg/l or less” cannot be usedas a relevant marker for the pharmacodynamic effect of the polypeptideof the invention in subjects that also receive MTX therapy, but only insubjects that do not receive methotrexate (MTX) therapy.

Methods are provided for inhibiting IL-6 mediated signaling in a subjectthat include administering to the subject a polypeptide of the inventionin an amount from about 3 mg/kg to about 10 mg/kg, wherein CRP levels inserum are decreased for at least 4 weeks after administration. In someembodiments, the serum level of CRP is decreased by and maintained at30% or more, 40% or more, 50% or more, 60% or more, or even 70% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levels.In a specific aspect, the levels of CRP are decreased by and maintainedat 30% or more (reduction) compared to baseline (i.e. pre-treatment ornormal) levels for up to at least 5 weeks, at least 6 weeks, at least 7weeks, at least 8 weeks, at least 9 weeks, at least 10 weeks, at least11 weeks, or even at least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 10 mg/kg, whereinthe levels of CRP are decreased by and maintained at 40% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levelsfor up to at least 5 weeks, at least 6 weeks, at least 7 weeks, at least8 weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks, or evenat least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 10 mg/kg, whereinthe levels of CRP are decreased by and maintained at 50% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levelsfor up to at least 5 weeks, at least 6 weeks, at least 7 weeks, at least8 weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks, or evenat least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 10 mg/kg, whereinthe levels of CRP are decreased by and maintained at 60% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levelsfor up to at least 5 weeks, at least 6 weeks, at least 7 weeks, at least8 weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks, or evenat least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 10 mg/kg, whereinthe levels of CRP are decreased by and maintained at 70% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levelsfor up to at least 5 weeks, at least 6 weeks, at least 7 weeks, at least8 weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks, or evenat least 12 weeks after administration.

In a further aspect, methods are provided for inhibiting IL-6 mediatedsignaling in a subject that include administering to the subject apolypeptide of the invention in an amount from about 3 mg/kg to about 6mg/kg, wherein CRP levels in serum are decreased for at least 4 weeksafter administration. In some embodiments, the serum level of CRP isdecreased by and maintained at 30% or more, 40% or more, 50% or more,60% or more, or even 70% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels. In a specific aspect, the levels of CRPare decreased by and maintained at 30% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels for up to at least 5weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least 9weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 6 mg/kg, whereinthe levels of CRP are decreased by and maintained at 40% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levelsfor up to at least 5 weeks, at least 6 weeks, at least 7 weeks, at least8 weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks, or evenat least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 6 mg/kg, whereinthe levels of CRP are decreased by and maintained at 50% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levelsfor up to at least 5 weeks, at least 6 weeks, at least 7 weeks, at least8 weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks, or evenat least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 6 mg/kg, whereinthe levels of CRP are decreased by and maintained at 60% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levelsup to at least 5 weeks, at least 6 weeks, at least 7 weeks, at least 8weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks, or evenat least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 6 mg/kg, whereinthe levels of CRP are decreased by and maintained at 70% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levelsfor up to at least 5 weeks, at least 6 weeks, at least 7 weeks, at least8 weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks, or evenat least 12 weeks after administration.

Methods are provided for inhibiting IL-6 mediated signaling in a subjectthat include administering to the subject a polypeptide of the inventionin an amount of about 3 mg/kg, wherein CRP levels in serum are decreasedfor at least 4 weeks after administration. In some embodiments, theserum level of CRP is decreased by and maintained at 30% or more, 40% ormore, 50% or more, 60% or more, or even 70% or more (reduction) comparedto baseline (i.e. pre-treatment or normal) levels. In a specific aspect,the levels of CRP are decreased by and maintained at 30% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levelsfor up to at least 5 weeks, at least 6 weeks, at least 7 weeks, at least8 weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks, or evenat least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 3 mg/kg, wherein the levels of CRPare decreased by and maintained at 40% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels for up to at least 5weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least 9weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 3 mg/kg, wherein the levels of CRPare decreased by and maintained at 50% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels for up to at least 5weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least 9weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 3 mg/kg, wherein the levels of CRPare decreased by and maintained at 60% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels for up to at least 5weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least 9weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 3 mg/kg, wherein the levels of CRPare decreased by and maintained at 70% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels for up to at least 5weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least 9weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

Methods are provided for inhibiting IL-6 mediated signaling in a subjectthat include administering to the subject a polypeptide of the inventionin an amount of about 6 mg/kg, wherein CRP levels in serum are decreasedfor at least 4 weeks after administration. In some embodiments, theserum level of CRP is decreased by and maintained at 30% or more, 40% ormore, 50% or more, 60% or more, or even 70% or more (reduction) comparedto baseline (i.e. pre-treatment or normal) levels. In a specific aspect,the levels of CRP are decreased by and maintained at 30% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levelsfor up to at least 5 weeks, at least 6 weeks, at least 7 weeks, at least8 weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks, or evenat least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 6 mg/kg, wherein the levels of CRPare decreased by and maintained at 40% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels for up to at least 5weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least 9weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 6 mg/kg, wherein the levels of CRPare decreased by and maintained at 50% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels for up to at least 5weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least 9weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 6 mg/kg, wherein the levels of CRPare decreased by and maintained at 60% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels for up to at least 5weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least 9weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 6 mg/kg, wherein the levels of CRPare decreased by and maintained at 70% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels for up to at least 5weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least 9weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

A preferred dosage schedule includes 3 mg/kg of polypeptide of theinvention every 4 weeks, wherein the levels of CRP are decreased by andmaintained at 30% or more, 40% or more, 50% or more, 60% or more, oreven 70% or more (reduction) compared to baseline (i.e. pre-treatment ornormal) levels.

Another preferred dosage schedule includes 6 mg/kg of polypeptide of theinvention every 4 weeks, wherein the levels of CRP are decreased by andmaintained at 30% or more, 40% or more, 50% or more, 60% or more, oreven 70% or more (reduction) compared to baseline (i.e. pre-treatment ornormal) levels.

Another preferred dosage schedule includes 6 mg/kg of polypeptide of theinvention every 8 weeks, wherein the levels of CRP are decreased by andmaintained at 30% or more, 40% or more, 50% or more, 60% or more, oreven 70% or more (reduction) compared to baseline (i.e. pre-treatment ornormal) levels.

In a preferred aspect, the polypeptide of the invention is SEQ ID NO:34.

Accordingly, the present invention relates to a method for inhibitingIL-6 mediated signaling in a subject, said method comprisingadministering to the subject a polypeptide with SEQ ID NO: 34 in anamount of 3 mg/kg of polypeptide with SEQ ID NO: 34 every 4 weeks,wherein CRP levels in serum are decreased by and maintained at 50% ormore (reduction) compared to baseline (i.e. pre-treatment or normal)levels. The invention thus also relates to a polypeptide with SEQ ID NO:34 for inhibiting IL-6 mediated signaling, wherein the polypeptide isadministered in an amount of 3 mg/kg of polypeptide with SEQ ID NO: 34every 4 weeks and wherein CRP levels in serum are decreased by andmaintained at 50% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels. The invention also relates to apolypeptide with SEQ ID NO: 34 for treatment of diseases and/ordisorders associated with IL-6 mediated signaling, wherein thepolypeptide is administered in an amount of 3 mg/kg of polypeptide withSEQ ID NO: 34 every 4 weeks and wherein CRP levels in serum aredecreased by and maintained at 50% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels.

In a preferred aspect, the levels of CRP are decreased by and maintainedat 30% or more, 40% or more, 50% or more, 60% or more, or even 70% ormore (reduction) compared to baseline (i.e. pre-treatment or normal)levels.

The present invention also relates to a method for inhibiting IL-6mediated signaling in a subject, said method comprising administering tothe subject a polypeptide with SEQ ID NO: 34 in an amount of 6 mg/kg ofpolypeptide with SEQ ID NO: 34 every 4 weeks, wherein CRP levels inserum are decreased by and maintained at 50% or more (reduction)compared to baseline (i.e. pre-treatment or normal) levels. Theinvention thus also relates to a polypeptide with SEQ ID NO: 34 forinhibiting IL-6 mediated signaling, wherein the polypeptide isadministered in an amount of 6 mg/kg of polypeptide with SEQ ID NO: 34every 4 weeks and wherein CRP levels in serum are decreased by andmaintained at 50% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels. The invention also relates to apolypeptide with SEQ ID NO: 34 for treatment of diseases and/ordisorders associated with IL-6 mediated signaling, wherein thepolypeptide is administered in an amount of 6 mg/kg of polypeptide withSEQ ID NO: 34 every 4 weeks and wherein CRP levels in serum aredecreased by and maintained at 50% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels.

In a preferred aspect, the levels of CRP are decreased by and maintainedat 30% or more, 40% or more, 50% or more, 60% or more, or even 70% ormore (reduction) compared to baseline (i.e. pre-treatment or normal)levels.

The present invention also relates to a method for inhibiting IL-6mediated signaling in a subject, said method comprising administering tothe subject a polypeptide with SEQ ID NO: 34 in an amount of 6 mg/kg ofpolypeptide with SEQ ID NO: 34 every 8 weeks, wherein CRP levels inserum are decreased by and maintained at 50% or more (reduction)compared to baseline (i.e. pre-treatment or normal) levels. Theinvention thus also relates to a polypeptide with SEQ ID NO: 34 forinhibiting IL-6 mediated signaling, wherein the polypeptide isadministered in an amount of 6 mg/kg of polypeptide with SEQ ID NO: 34every 8 weeks and wherein CRP levels in serum are decreased by andmaintained at 50% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels. The invention also relates to apolypeptide with SEQ ID NO: 34 for treatment of diseases and/ordisorders associated with IL-6 mediated signaling, wherein thepolypeptide is administered in an amount of 6 mg/kg of polypeptide withSEQ ID NO: 34 every 8 weeks and wherein CRP levels in serum aredecreased by and maintained at 50% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels.

In a preferred aspect, the levels of CRP are decreased by and maintainedat 30% or more, 40% or more, 50% or more, 60% or more, or even 70% ormore (reduction) compared to baseline (i.e. pre-treatment or normal)levels.

Methods are provided for inhibiting IL-6 mediated signaling in a subjectthat include administering to the subject a polypeptide of the inventionin an amount from about 3 mg/kg to about 10 mg/kg, wherein ESR levels inserum are decreased for at least 4 weeks after administration. In someembodiments, the serum level of ESR is decreased by and maintained at30% or more, 40% or more, 50% or more, 60% or more, or even 70% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levels.In a specific aspect, the levels of ESR are decreased by and maintainedat 30% or more (reduction) compared to baseline (i.e. pre-treatment ornormal) levels for up to at least 5 weeks, at least 6 weeks, at least 7weeks, at least 8 weeks, at least 9 weeks, at least 10 weeks, at least11 weeks, or even at least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 10 mg/kg, whereinthe levels of ESR are decreased by and maintained at 40% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levelsfor up to at least 5 weeks, at least 6 weeks, at least 7 weeks, at least8 weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks, or evenat least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 10 mg/kg, whereinthe levels of ESR are decreased by and maintained at 50% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levelsfor up to at least 5 weeks, at least 6 weeks, at least 7 weeks, at least8 weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks, or evenat least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 10 mg/kg, whereinthe levels of ESR are decreased by and maintained at 60% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levelsfor up to at least 5 weeks, at least 6 weeks, at least 7 weeks, at least8 weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks, or evenat least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 10 mg/kg, whereinthe levels of ESR are decreased by and maintained at 70% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levelsfor up to at least 5 weeks, at least 6 weeks, at least 7 weeks, at least8 weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks, or evenat least 12 weeks after administration.

In a further aspect, methods are provided for inhibiting IL-6 mediatedsignaling in a subject that include administering to the subject apolypeptide of the invention in an amount from about 3 mg/kg to about 6mg/kg, wherein ESR levels in serum are decreased for at least 4 weeksafter administration. In some embodiments, the serum level of ESR isdecreased by and maintained at 30% or more, 40% or more, 50% or more,60% or more, or even 70% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels. In a specific aspect, the levels of ESRare decreased by and maintained at 30% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels for up to at least 5weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least 9weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 6 mg/kg, whereinthe levels of ESR are decreased by and maintained at 40% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levelsfor up to at least 5 weeks, at least 6 weeks, at least 7 weeks, at least8 weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks, or evenat least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 6 mg/kg, whereinthe levels of ESR are decreased by and maintained at 50% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levelsfor up to at least 5 weeks, at least 6 weeks, at least 7 weeks, at least8 weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks, or evenat least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 6 mg/kg, whereinthe levels of ESR are decreased by and maintained at 60% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levelsup to at least 5 weeks, at least 6 weeks, at least 7 weeks, at least 8weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks, or evenat least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 6 mg/kg, whereinthe levels of ESR are decreased by and maintained at 70% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levelsfor up to at least 5 weeks, at least 6 weeks, at least 7 weeks, at least8 weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks, or evenat least 12 weeks after administration.

Methods are provided for inhibiting IL-6 mediated signaling in a subjectthat include administering to the subject a polypeptide of the inventionin an amount of about 3 mg/kg, wherein ESR levels in serum are decreasedfor at least 4 weeks after administration. In some embodiments, theserum level of ESR is decreased by and maintained at 30% or more, 40% ormore, 50% or more, 60% or more, 70% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels. In a specific aspect,the levels of ESR are decreased by and maintained at 30% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levelsfor up to at least 5 weeks, at least 6 weeks, at least 7 weeks, at least8 weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks, or evenat least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 3 mg/kg, wherein the levels of ESRare decreased by and maintained at 40% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels for up to at least 5weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least 9weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 3 mg/kg, wherein the levels of ESRare decreased by and maintained at 50% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels for up to at least 5weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least 9weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 3 mg/kg, wherein the levels of ESRare decreased by and maintained at 60% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels for up to at least 5weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least 9weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 3 mg/kg, wherein the levels of ESRare decreased by and maintained at 70% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels for up to at least 5weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least 9weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

Methods are provided for inhibiting IL-6 mediated signaling in a subjectthat include administering to the subject a polypeptide of the inventionin an amount of about 6 mg/kg, wherein ESR levels in serum are decreasedfor at least 4 weeks after administration. In some embodiments, theserum level of ESR is decreased by and maintained at 30% or more, 40% ormore, 50% or more, 60% or more, or even 70% or more (reduction) comparedto baseline (i.e. pre-treatment or normal) levels. In a specific aspect,the levels of ESR are decreased by and maintained at 30% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levelsfor up to at least 5 weeks, at least 6 weeks, at least 7 weeks, at least8 weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks, or evenat least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 6 mg/kg, wherein the levels of ESRare decreased by and maintained at 40% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels for up to at least 5weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least 9weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 6 mg/kg, wherein the levels of ESRare decreased by and maintained at 50% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels for up to at least 5weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least 9weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 6 mg/kg, wherein the levels of ESRare decreased by and maintained at 60% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels for up to at least 5weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least 9weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 6 mg/kg, wherein the levels of ESRare decreased by and maintained at 70% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels for up to at least 5weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least 9weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

A preferred dosage schedule includes 3 mg/kg of polypeptide of theinvention every 4 weeks, wherein the levels of ESR are decreased by andmaintained at 30% or more, 40% or more, 50% or more, 60% or more, oreven 70% or more (reduction) compared to baseline (i.e. pre-treatment ornormal) levels.

Another preferred dosage schedule includes 6 mg/kg of polypeptide of theinvention every 4 weeks, wherein the levels of ESR are decreased by andmaintained at 30% or more, 40% or more, 50% or more, 60% or more, oreven 70% or more (reduction) compared to baseline (i.e. pre-treatment ornormal) levels.

Another preferred dosage schedule includes 6 mg/kg of polypeptide of theinvention every 8 weeks, wherein the levels of ESR are decreased by andmaintained at 30% or more, 40% or more, 50% or more, 60% or more, oreven 70% or more (reduction) compared to baseline (i.e. pre-treatment ornormal) levels.

In a preferred aspect, the polypeptide of the invention is SEQ ID NO:34.

Accordingly, the present invention relates to a method for inhibitingIL-6 mediated signaling in a subject, said method comprisingadministering to the subject a polypeptide with SEQ ID NO: 34 in anamount of 3 mg/kg of polypeptide with SEQ ID NO: 34 every 4 weeks,wherein ESR levels in serum are decreased by and maintained at 30% ormore (reduction) compared to baseline (i.e. pre-treatment or normal)levels. The invention thus also relates to a polypeptide with SEQ ID NO:34 for inhibiting IL-6 mediated signaling, wherein the polypeptide isadministered in an amount of 3 mg/kg of polypeptide with SEQ ID NO: 34every 4 weeks and wherein ESR levels in serum are decreased by andmaintained at 30% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels. The invention also relates to apolypeptide with SEQ ID NO: 34 for treatment of diseases and/ordisorders associated with IL-6 mediated signaling, wherein thepolypeptide is administered in an amount of 3 mg/kg of polypeptide withSEQ ID NO: 34 every 4 weeks and wherein ESR levels in serum aredecreased by and maintained at 30% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels.

In a preferred aspect, the levels of ESR are decreased by and maintainedat 30% or more, 40% or more, 50% or more, 60% or more, or even 70% ormore (reduction) compared to baseline (i.e. pre-treatment or normal)levels.

The present invention also relates to a method for inhibiting IL-6mediated signaling in a subject, said method comprising administering tothe subject a polypeptide with SEQ ID NO: 34 in an amount of 6 mg/kg ofpolypeptide with SEQ ID NO: 34 every 4 weeks, wherein ESR levels inserum are decreased by and maintained at 30% or more (reduction)compared to baseline (i.e. pre-treatment or normal) levels. Theinvention thus also relates to a polypeptide with SEQ ID NO: 34 forinhibiting IL-6 mediated signaling, wherein the polypeptide isadministered in an amount of 6 mg/kg of polypeptide with SEQ ID NO: 34every 4 weeks and wherein ESR levels in serum are decreased by andmaintained at 30% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels. The invention also relates to apolypeptide with SEQ ID NO: 34 for treatment of diseases and/ordisorders associated with IL-6 mediated signaling, wherein thepolypeptide is administered in an amount of 6 mg/kg of polypeptide withSEQ ID NO: 34 every 4 weeks and wherein ESR levels in serum aredecreased by and maintained at 30% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels.

In a preferred aspect, the levels of ESR are decreased by and maintainedat 30% or more, 40% or more, 50% or more, 60% or more, or even 70% ormore (reduction) compared to baseline (i.e. pre-treatment or normal)levels.

The present invention also relates to a method for inhibiting IL-6mediated signaling in a subject, said method comprising administering tothe subject a polypeptide with SEQ ID NO: 34 in an amount of 6 mg/kg ofpolypeptide with SEQ ID NO: 34 every 8 weeks, wherein ESR levels inserum are decreased by and maintained at 30% or more (reduction)compared to baseline (i.e. pre-treatment or normal) levels. Theinvention thus also relates to a polypeptide with SEQ ID NO: 34 forinhibiting IL-6 mediated signaling, wherein the polypeptide isadministered in an amount of 6 mg/kg of polypeptide with SEQ ID NO: 34every 8 weeks and wherein ESR levels in serum are decreased by andmaintained at 30% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels. The invention also relates to apolypeptide with SEQ ID NO: 34 for treatment of diseases and/ordisorders associated with IL-6 mediated signaling, wherein thepolypeptide is administered in an amount of 6 mg/kg of polypeptide withSEQ ID NO: 34 every 8 weeks and wherein ESR levels in serum aredecreased by and maintained at 30% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels.

In a preferred aspect, the levels of ESR are decreased by and maintainedat 30% or more, 40% or more, 50% or more, 60% or more, or even 70% ormore (reduction) compared to baseline (i.e. pre-treatment or normal)levels.

Methods are provided for inhibiting IL-6 mediated signaling in a subjectthat include administering to the subject a polypeptide of the inventionin an amount from about 3 mg/kg to about 10 mg/kg, wherein fibrinogenlevels in serum are decreased for at least 4 weeks after administration.In some embodiments, the serum level of fibrinogen is decreased by andmaintained at 20% or more, 30% or more, 40% or more, or even 50% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levels.In a specific aspect, the levels of fibrinogen are decreased by andmaintained at 20% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels for up to at least 5 weeks, at least 6weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, at least 10weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 10 mg/kg, whereinthe levels of fibrinogen are decreased by and maintained at 30% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levelsfor up to at least 5 weeks, at least 6 weeks, at least 7 weeks, at least8 weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks, or evenat least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 10 mg/kg, whereinthe levels of fibrinogen are decreased by and maintained at 40% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levelsfor up to at least 5 weeks, at least 6 weeks, at least 7 weeks, at least8 weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks, or evenat least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 10 mg/kg, whereinthe levels of fibrinogen are decreased by and maintained at 50% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levelsfor up to at least 5 weeks, at least 6 weeks, at least 7 weeks, at least8 weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks, or evenat least 12 weeks after administration.

In a further aspect, methods are provided for inhibiting IL-6 mediatedsignaling in a subject that include administering to the subject apolypeptide of the invention in an amount from about 3 mg/kg to about 6mg/kg, wherein fibrinogen levels in serum are decreased for at least 4weeks after administration. In some embodiments, the serum level offibrinogen is decreased by and maintained at 20% or more, 30% or more,40% or more, or even 50% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels. In a specific aspect, the levels offibrinogen are decreased by and maintained at 20% or more (reduction)compared to baseline (i.e. pre-treatment or normal) levels for up to atleast 5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, atleast 9 weeks, at least 10 weeks, at least 11 weeks, or even at least 12weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 6 mg/kg, whereinthe levels of fibrinogen are decreased by and maintained at 30% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levelsfor up to at least 5 weeks, at least 6 weeks, at least 7 weeks, at least8 weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks, or evenat least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 6 mg/kg, whereinthe levels of fibrinogen are decreased by and maintained at 40% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levelsfor up to at least 5 weeks, at least 6 weeks, at least 7 weeks, at least8 weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks, or evenat least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 6 mg/kg, whereinthe levels of fibrinogen are decreased by and maintained at 50% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levelsfor up to at least 5 weeks, at least 6 weeks, at least 7 weeks, at least8 weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks, or evenat least 12 weeks after administration.

Methods are provided for inhibiting IL-6 mediated signaling in a subjectthat include administering to the subject a polypeptide of the inventionin an amount of about 3 mg/kg, wherein fibrinogen levels in serum aredecreased for at least 4 weeks after administration. In someembodiments, the serum level of fibrinogen is decreased by andmaintained at 20% or more, 30% or more, 40% or more, or even 50% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levels.In a specific aspect, the levels of fibrinogen are decreased by andmaintained at 20% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels for up to at least 5 weeks, at least 6weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, at least 10weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In a specific aspect, a polypeptide of the invention is administered inan amount of about 3 mg/kg, wherein the levels of fibrinogen aredecreased by and maintained at 30% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels for up to at least 5weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least 9weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 3 mg/kg, wherein the levels offibrinogen are decreased by and maintained at 40% or more (reduction)compared to baseline (i.e. pre-treatment or normal) levels for up to atleast 5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, atleast 9 weeks, at least 10 weeks, at least 11 weeks, or even at least 12weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 3 mg/kg, wherein the levels offibrinogen are decreased by and maintained at 50% or more (reduction)compared to baseline (i.e. pre-treatment or normal) levels for up to atleast 5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, atleast 9 weeks, at least 10 weeks, at least 11 weeks, or even at least 12weeks after administration.

Methods are provided for inhibiting IL-6 mediated signaling in a subjectthat include administering to the subject a polypeptide of the inventionin an amount of about 6 mg/kg, wherein fibrinogen levels in serum aredecreased for at least 4 weeks after administration. In someembodiments, the serum level of fibrinogen is decreased by andmaintained at 20% or more, 30% or more, 40% or more, or even 50% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levels.In a specific aspect, the levels of fibrinogen are decreased by andmaintained at 20% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels for up to at least 5 weeks, at least 6weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, at least 10weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 6 mg/kg, wherein the levels offibrinogen are decreased by and maintained at 30% or more (reduction)compared to baseline (i.e. pre-treatment or normal) levels for up to atleast 5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, atleast 9 weeks, at least 10 weeks, at least 11 weeks, or even at least 12weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 6 mg/kg, wherein the levels offibrinogen are decreased by and maintained at 40% or more (reduction)compared to baseline (i.e. pre-treatment or normal) levels for up to atleast 5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, atleast 9 weeks, at least 10 weeks, at least 11 weeks, or even at least 12weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 6 mg/kg, wherein the levels offibrinogen are decreased by and maintained at 50% or more (reduction)compared to baseline (i.e. pre-treatment or normal) levels for up to atleast 5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, atleast 9 weeks, at least 10 weeks, at least 11 weeks, or even at least 12weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 6 mg/kg, wherein the levels offibrinogen are decreased by and maintained at 60% or more (reduction)compared to baseline (i.e. pre-treatment or normal) levels for up to atleast 5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, atleast 9 weeks, at least 10 weeks, at least 11 weeks, or even at least 12weeks after administration.

A preferred dosage schedule includes 3 mg/kg of polypeptide of theinvention every 4 weeks, wherein the levels of fibrinogen are decreasedby and maintained at 20% or more, 30% or more, 40% or more, or even 50%or more (reduction) compared to baseline (i.e. pre-treatment or normal)levels.

Another preferred dosage schedule includes 6 mg/kg of polypeptide of theinvention every 4 weeks, wherein the levels of fibrinogen are decreasedby and maintained at 20% or more, 30% or more, 40% or more, or even 50%or more (reduction) compared to baseline (i.e. pre-treatment or normal)levels.

Another preferred dosage schedule includes 6 mg/kg of polypeptide of theinvention every 8 weeks, wherein the levels of fibrinogen are decreasedby and maintained at 20% or more, 30% or more, 40% or more, or even 50%or more (reduction) compared to baseline (i.e. pre-treatment or normal)levels.

In a preferred aspect, the polypeptide of the invention is SEQ ID NO:34.

Accordingly, the present invention relates to a method for inhibitingIL-6 mediated signaling in a subject, said method comprisingadministering to the subject a polypeptide with SEQ ID NO: 34 in anamount of 3 mg/kg of polypeptide with SEQ ID NO: 34 every 4 weeks,wherein fibrinogen levels in serum are decreased by and maintained at30% or more (reduction) compared to baseline (i.e. pre-treatment ornormal) levels. The invention thus also relates to a polypeptide withSEQ ID NO: 34 for inhibiting IL-6 mediated signaling, wherein thepolypeptide is administered in an amount of 3 mg/kg of polypeptide withSEQ ID NO: 34 every 4 weeks and wherein fibrinogen levels in serum aredecreased by and maintained at 30% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels. The invention alsorelates to a polypeptide with SEQ ID NO: 34 for treatment of diseasesand/or disorders associated with IL-6 mediated signaling, wherein thepolypeptide is administered in an amount of 3 mg/kg of polypeptide withSEQ ID NO: 34 every 4 weeks and wherein fibrinogen levels in serum aredecreased by and maintained at 30% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels.

In a preferred aspect, the levels of fibrinogen are decreased by andmaintained at 20% or more, 30% or more, 40% or more, or even 50% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levels.

The present invention also relates to a method for inhibiting IL-6mediated signaling in a subject, said method comprising administering tothe subject a polypeptide with SEQ ID NO: 34 in an amount of 6 mg/kg ofpolypeptide with SEQ ID NO: 34 every 4 weeks, wherein fibrinogen levelsin serum are decreased by and maintained at 30% or more (reduction)compared to baseline (i.e. pre-treatment or normal) levels. Theinvention thus also relates to a polypeptide with SEQ ID NO: 34 forinhibiting IL-6 mediated signaling, wherein the polypeptide isadministered in an amount of 6 mg/kg of polypeptide with SEQ ID NO: 34every 4 weeks and wherein fibrinogen levels in serum are decreased byand maintained at 30% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels. The invention also relates to apolypeptide with SEQ ID NO: 34 for treatment of diseases and/ordisorders associated with IL-6 mediated signaling, wherein thepolypeptide is administered in an amount of 6 mg/kg of polypeptide withSEQ ID NO: 34 every 4 weeks and wherein fibrinogen levels in serum aredecreased by and maintained at 30% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels.

In a preferred aspect, the levels of fibrinogen are decreased by andmaintained at 20% or more, 30% or more, 40% or more, or even 50% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levels.

The present invention also relates to a method for inhibiting IL-6mediated signaling in a subject, said method comprising administering tothe subject a polypeptide with SEQ ID NO: 34 in an amount of 6 mg/kg ofpolypeptide with SEQ ID NO: 34 every 8 weeks, wherein fibrinogen levelsin serum are decreased by and maintained at 30% or more (reduction)compared to baseline (i.e. pre-treatment or normal) levels. Theinvention thus also relates to a polypeptide with SEQ ID NO: 34 forinhibiting IL-6 mediated signaling, wherein the polypeptide isadministered in an amount of 6 mg/kg of polypeptide with SEQ ID NO: 34every 8 weeks and wherein fibrinogen levels in serum are decreased byand maintained at 30% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels. The invention also relates to apolypeptide with SEQ ID NO: 34 for treatment of diseases and/ordisorders associated with IL-6 mediated signaling, wherein thepolypeptide is administered in an amount of 6 mg/kg of polypeptide withSEQ ID NO: 34 every 8 weeks and wherein fibrinogen levels in serum aredecreased by and maintained at 30% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels.

In a preferred aspect, the levels of fibrinogen are decreased by andmaintained at 20% or more, 30% or more, 40% or more, or even 50% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levels.

Methods are provided for inhibiting IL-6 mediated signaling in a subjectthat include administering to the subject a polypeptide of the inventionin an amount from about 3 mg/kg to about 10 mg/kg, wherein serum amyloidA levels are decreased for at least 4 weeks after administration. Insome embodiments, the serum amyloid A level is decreased by andmaintained at 30% or more, 40% or more, 50% or more, 60% or more, oreven 70% or more (reduction) compared to baseline (i.e. pre-treatment ornormal) levels. In a specific aspect, the serum amyloid A levels aredecreased by and maintained at 30% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels for up to at least 5weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least 9weeks, at least 10 weeks, at least 11 weeks, or even at least 12 weeksafter administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 10 mg/kg, whereinthe serum amyloid A levels are decreased by and maintained at 40% ormore (reduction) compared to baseline (i.e. pre-treatment or normal)levels for up to at least 5 weeks, at least 6 weeks, at least 7 weeks,at least 8 weeks, at least 9 weeks, at least 10 weeks, at least 11weeks, or even at least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 10 mg/kg, whereinthe serum amyloid A levels are decreased by and maintained at 50% ormore (reduction) compared to baseline (i.e. pre-treatment or normal)levels for up to at least 5 weeks, at least 6 weeks, at least 7 weeks,at least 8 weeks, at least 9 weeks, at least 10 weeks, at least 11weeks, or even at least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 10 mg/kg, whereinthe serum amyloid A levels are decreased by and maintained at 60% ormore (reduction) compared to baseline (i.e. pre-treatment or normal)levels for up to at least 5 weeks, at least 6 weeks, at least 7 weeks,at least 8 weeks, at least 9 weeks, at least 10 weeks, at least 11weeks, or even at least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 10 mg/kg, whereinthe serum amyloid A levels are decreased by and maintained at 70% ormore (reduction) compared to baseline (i.e. pre-treatment or normal)levels for up to at least 5 weeks, at least 6 weeks, at least 7 weeks,at least 8 weeks, at least 9 weeks, at least 10 weeks, at least 11weeks, or even at least 12 weeks after administration.

In a further aspect, methods are provided for inhibiting IL-6 mediatedsignaling in a subject that include administering to the subject apolypeptide of the invention in an amount from about 3 mg/kg to about 6mg/kg, wherein serum amyloid A levels are decreased for at least 4 weeksafter administration. In some embodiments, the serum amyloid A level isdecreased by and maintained at 30% or more, 40% or more, 50% or more,60% or more, or even 70% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels. In a specific aspect, the serum amyloidA levels are decreased by and maintained at 30% or more (reduction)compared to baseline (i.e. pre-treatment or normal) levels for up to atleast 5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, atleast 9 weeks, at least 10 weeks, at least 11 weeks, or even at least 12weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 6 mg/kg, whereinthe serum amyloid A levels are decreased by and maintained at 40% ormore (reduction) compared to baseline (i.e. pre-treatment or normal)levels for up to at least 5 weeks, at least 6 weeks, at least 7 weeks,at least 8 weeks, at least 9 weeks, at least 10 weeks, at least 11weeks, or even at least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 6 mg/kg, whereinthe serum amyloid A levels are decreased by and maintained at 50% ormore (reduction) compared to baseline (i.e. pre-treatment or normal)levels for up to at least 5 weeks, at least 6 weeks, at least 7 weeks,at least 8 weeks, at least 9 weeks, at least 10 weeks, at least 11weeks, or even at least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 6 mg/kg, whereinthe serum amyloid A levels are decreased by and maintained at 60% ormore (reduction) compared to baseline (i.e. pre-treatment or normal)levels up to at least 5 weeks, at least 6 weeks, at least 7 weeks, atleast 8 weeks, at least 9 weeks, at least 10 weeks, at least 11 weeks,or even at least 12 weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount from about 3 mg/kg to about 6 mg/kg, whereinthe serum amyloid A levels are decreased by and maintained at 70% ormore (reduction) compared to baseline (i.e. pre-treatment or normal)levels for up to at least 5 weeks, at least 6 weeks, at least 7 weeks,at least 8 weeks, at least 9 weeks, at least 10 weeks, at least 11weeks, or even at least 12 weeks after administration.

Methods are provided for inhibiting IL-6 mediated signaling in a subjectthat include administering to the subject a polypeptide of the inventionin an amount of about 3 mg/kg, wherein serum amyloid A levels aredecreased for at least 4 weeks after administration. In someembodiments, the serum amyloid A level is decreased by and maintained at30% or more, 40% or more, 50% or more, 60% or more, or even 70% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levels.In a specific aspect, the serum amyloid A levels are decreased by andmaintained at 30% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels for up to at least 5 weeks, at least 6weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, at least 10weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 3 mg/kg, wherein the serum amyloid Alevels are decreased by and maintained at 40% or more (reduction)compared to baseline (i.e. pre-treatment or normal) levels for up to atleast 5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, atleast 9 weeks, at least 10 weeks, at least 11 weeks, or even at least 12weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 3 mg/kg, wherein the serum amyloid Alevels are decreased by and maintained at 50% or more (reduction)compared to baseline (i.e. pre-treatment or normal) levels for up to atleast 5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, atleast 9 weeks, at least 10 weeks, at least 11 weeks, or even at least 12weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 3 mg/kg, wherein the serum amyloid Alevels are decreased by and maintained at 60% or more (reduction)compared to baseline (i.e. pre-treatment or normal) levels for up to atleast 5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, atleast 9 weeks, at least 10 weeks, at least 11 weeks, or even at least 12weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 3 mg/kg, wherein the serum amyloid Alevels are decreased by and maintained at 70% or more (reduction)compared to baseline (i.e. pre-treatment or normal) levels for up to atleast 5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, atleast 9 weeks, at least 10 weeks, at least 11 weeks, or even at least 12weeks after administration.

Methods are provided for inhibiting IL-6 mediated signaling in a subjectthat include administering to the subject a polypeptide of the inventionin an amount of about 6 mg/kg, wherein serum amyloid A levels aredecreased for at least 4 weeks after administration. In someembodiments, the serum amyloid A level is decreased by and maintained at30% or more, 40% or more, 50% or more, 60% or more, or even 70% or more(reduction) compared to baseline (i.e. pre-treatment or normal) levels.In a specific aspect, the serum amyloid A levels are decreased by andmaintained at 30% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels for up to at least 5 weeks, at least 6weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, at least 10weeks, at least 11 weeks, or even at least 12 weeks afteradministration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 6 mg/kg, wherein the serum amyloid Alevels are decreased by and maintained at 40% or more (reduction)compared to baseline (i.e. pre-treatment or normal) levels for up to atleast 5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, atleast 9 weeks, at least 10 weeks, at least 11 weeks, or even at least 12weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 6 mg/kg, wherein the serum amyloid Alevels are decreased by and maintained at 50% or more (reduction)compared to baseline (i.e. pre-treatment or normal) levels for up to atleast 5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, atleast 9 weeks, at least 10 weeks, at least 11 weeks, or even at least 12weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 6 mg/kg, wherein the serum amyloid Alevels are decreased by and maintained at 60% or more (reduction)compared to baseline (i.e. pre-treatment or normal) levels for up to atleast 5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, atleast 9 weeks, at least 10 weeks, at least 11 weeks, or even at least 12weeks after administration.

In another specific aspect, a polypeptide of the invention isadministered in an amount of about 6 mg/kg, wherein the serum amyloid Alevels are decreased by and maintained at 70% or more (reduction)compared to baseline (i.e. pre-treatment or normal) levels for up to atleast 5 weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, atleast 9 weeks, at least 10 weeks, at least 11 weeks, or even at least 12weeks after administration.

A preferred dosage schedule includes 3 mg/kg of polypeptide of theinvention every 4 weeks, wherein the serum amyloid A levels aredecreased by and maintained at 30% or more, 40% or more, 50% or more,60% or more, or even 70% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels.

Another preferred dosage schedule includes 6 mg/kg of polypeptide of theinvention every 4 weeks, wherein the serum amyloid A levels aredecreased by and maintained at 30% or more, 40% or more, 50% or more,60% or more, or even 70% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels.

Another preferred dosage schedule includes 6 mg/kg of polypeptide of theinvention every 8 weeks, wherein the serum amyloid A levels aredecreased by and maintained at 30% or more, 40% or more, 50% or more,60% or more, or even 70% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels.

In a preferred aspect, the polypeptide of the invention is SEQ ID NO:34.

Accordingly, the present invention relates to a method for inhibitingIL-6 mediated signaling in a subject, said method comprisingadministering to the subject a polypeptide with SEQ ID NO: 34 in anamount of 3 mg/kg of polypeptide with SEQ ID NO: 34 every 4 weeks,wherein serum amyloid A levels are decreased by and maintained at 30% ormore (reduction) compared to baseline (i.e. pre-treatment or normal)levels. The invention thus also relates to a polypeptide with SEQ ID NO:34 for inhibiting IL-6 mediated signaling, wherein the polypeptide isadministered in an amount of 3 mg/kg of polypeptide with SEQ ID NO: 34every 4 weeks and wherein serum amyloid A levels are decreased by andmaintained at 30% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels. The invention also relates to apolypeptide with SEQ ID NO: 34 for treatment of diseases and/ordisorders associated with IL-6 mediated signaling, wherein thepolypeptide is administered in an amount of 3 mg/kg of polypeptide withSEQ ID NO: 34 every 4 weeks and wherein serum amyloid A levels aredecreased by and maintained at 30% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels.

In a preferred aspect, the serum amyloid A levels are decreased by andmaintained at 30% or more, 40% or more, 50% or more, 60% or more, oreven 70% or more (reduction) compared to baseline (i.e. pre-treatment ornormal) levels.

The present invention also relates to a method for inhibiting IL-6mediated signaling in a subject, said method comprising administering tothe subject a polypeptide with SEQ ID NO: 34 in an amount of 6 mg/kg ofpolypeptide with SEQ ID NO: 34 every 4 weeks, wherein serum amyloid Alevels are decreased by and maintained at 30% or more (reduction)compared to baseline (i.e. pre-treatment or normal) levels. Theinvention thus also relates to a polypeptide with SEQ ID NO: 34 forinhibiting IL-6 mediated signaling, wherein the polypeptide isadministered in an amount of 6 mg/kg of polypeptide with SEQ ID NO: 34every 4 weeks and wherein serum amyloid A levels are decreased by andmaintained at 30% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels. The invention also relates to apolypeptide with SEQ ID NO: 34 for treatment of diseases and/ordisorders associated with IL-6 mediated signaling, wherein thepolypeptide is administered in an amount of 6 mg/kg of polypeptide withSEQ ID NO: 34 every 4 weeks and wherein serum amyloid A levels aredecreased by and maintained at 30% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels.

In a preferred aspect, the serum amyloid A levels are decreased by andmaintained at 30% or more, 40% or more, 50% or more, 60% or more, oreven 70% or more (reduction) compared to baseline (i.e. pre-treatment ornormal) levels.

The present invention also relates to a method for inhibiting IL-6mediated signaling in a subject, said method comprising administering tothe subject a polypeptide with SEQ ID NO: 34 in an amount of 6 mg/kg ofpolypeptide with SEQ ID NO: 34 every 8 weeks, wherein serum amyloid Alevels are decreased by and maintained at 30% or more (reduction)compared to baseline (i.e. pre-treatment or normal) levels. Theinvention thus also relates to a polypeptide with SEQ ID NO: 34 forinhibiting IL-6 mediated signaling, wherein the polypeptide isadministered in an amount of 6 mg/kg of polypeptide with SEQ ID NO: 34every 8 weeks and wherein serum amyloid A levels are decreased by andmaintained at 30% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels. The invention also relates to apolypeptide with SEQ ID NO: 34 for treatment of diseases and/ordisorders associated with IL-6 mediated signaling, wherein thepolypeptide is administered in an amount of 6 mg/kg of polypeptide withSEQ ID NO: 34 every 8 weeks and wherein serum amyloid A levels aredecreased by and maintained at 30% or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels.

In a preferred aspect, the serum amyloid A levels are decreased by andmaintained at 30% or more, 40% or more, 50% or more, 60% or more, oreven 70% or more (reduction) compared to baseline (i.e. pre-treatment ornormal) levels.

Therapeutic Applications

The present invention provides methods and dosing schedules withpolypeptides that are directed against IL-6R, which provide unexpectedlyprolonged inhibition of IL-6 mediated signaling in a subject.

As such, the methods and dosing schedules of the present invention canbe used for the prevention and treatment (as defined herein) of diseasesand/or disorders related to IL-6 mediated signaling with lower dosesand/or less frequent dosing than used for other therapeutics. Generally,“diseases and/or disorders related to IL-6 mediated signaling” can bedefined as diseases and/or disorders that can be prevented and/ortreated, respectively, by suitably administering to a subject in needthereof (i.e. having the disease and/or disorder or at least one symptomthereof and/or at risk of attracting or developing the disease ordisorder) of either a polypeptide of the invention (and in particular,of a pharmaceutically active amount thereof) and/or of a known activeprinciple active against IL-6, IL-6R, the IL-6/IL-6R complex (optionallyin further complex with gp130) or a biological pathway or mechanism inwhich IL-6 and IL-6R are involved (and in particular, of apharmaceutically active amount thereof).

Diseases and/or disorders related to IL-6 mediated signaling encompassdiseases and disorders associated with IL-6R, with IL-6, with theIL-6/IL-6R complex (optionally in further complex with gp130), and/orwith the signaling pathway(s) and/or the biological functions andresponses in which IL-6, IL-6R and/or the IL-6/IL-6R complex (optionallyin further complex with gp130) are involved, and in particular diseasesand disorders associated with IL-6R, with IL-6, with the IL-6/IL-6Rcomplex (optionally in further complex with gp130), and/or with thesignaling pathway(s) and/or the biological functions and responses inwhich IL-6R, IL-6 and/or the IL-6/IL-6R complex (optionally in furthercomplex with gp130) are involved, which are characterized by excessiveand/or unwanted signaling mediated by IL-6 or by the pathway(s) in whichIL-6 is involved. Examples of such diseases and disorders associatedwith IL-6R, with IL-6, with the IL-6/IL-6R complex, and/or with thesignaling pathway(s) and/or the biological functions and responses inwhich IL-6, IL-6R and/or the IL-6/IL-6R complex are involved, will beclear to the skilled person based on the disclosure herein, and forexample include the following diseases and disorders: sepsis (Starnes etal. 1999, J. Immunol. 148: 1968) and various forms of cancer such asmultiple myeloma disease (MM), renal cell carcinoma (RCC), plasma cellleukaemia (Klein et al. 1991, Blood 78: 1198-1204), lymphoma,B-lymphoproliferative disorder (BLPD) and prostate cancer. Non-limitingexamples of other diseases caused by excessive IL-6 production orsignaling include bone resorption (osteoporosis) (Roodman et al. 1992,J. Clin. Invest. 89: 45-52; Jilka et al. 1992, Science 257: 88-91),cachexia (Strassman et al. 1992, J. Clin. Invest. 89: 1681-1684),psoriasis, mesangial proliferative glomerulonephritis, Kaposi's sarcoma,AIDS-related lymphoma (Emilie et al. 1994, Blood 84: 2472-2479),inflammatory diseases and disorder such as rheumatoid arthritis,systemic onset juvenile idiopathic arthritis, hypergammaglobulinemia(Grau et al. 1990, J. Exp. Med. 172: 1505-1508), Crohn's disease,ulcerative colitis, systemic lupus erythematosus (SLE), multiplesclerosis, Castleman's disease, IgM gammopathy, cardiac myxoma, asthma(in particular allergic asthma) and autoimmune insulin-dependentdiabetes mellitus (Campbell et al. 1991, J. Clin. Invest. 87: 739-742).Other IL-6R, IL-6 and/or IL-6/IL-6R complex related disorders will beclear to the skilled person. Such diseases and disorders are alsogenerally referred to herein as “IL-6R related diseases and/ordisorders” or “IL-6 related diseases and/or disorders”.

The methods and dosing schedules of the present invention that modulate,and in particular inhibit and/or prevent for prolonged periods of timeand/or at lower doses and/or by less frequent dosing, binding of IL-6 toIL-6R, act as antagonist and will generally be used for the preventionand treatment (as defined herein) of these “IL-6R related diseasesand/or disorders”, “IL-6 related diseases and/or disorders” and/or“diseases and/or disorders related to IL-6 mediated signaling”.

The invention thus also relates to a polypeptide of the invention forthe prevention and treatment (as defined herein) of these “IL-6R relateddiseases and/or disorders”, “IL-6 related diseases and/or disorders”and/or “diseases and/or disorders related to IL-6 mediated signaling”wherein the polypeptide inhibit and/or prevent for prolonged periods oftime and/or at lower doses and/or by less frequent dosing, binding ofIL-6 to IL-6R.

In the context of the present invention, the term “prevention and/ortreatment” not only comprises preventing and/or treating the disease,but also generally comprises preventing the onset of the disease,slowing or reversing the progress of disease, preventing or slowing theonset of one or more symptoms associated with the disease, reducingand/or alleviating one or more symptoms associated with the disease,reducing the severity and/or the duration of the disease and/or of anysymptoms associated therewith and/or preventing a further increase inthe severity of the disease and/or of any symptoms associated therewith,preventing, reducing or reversing any physiological damage caused by thedisease, and generally any pharmacological action that is beneficial tothe patient being treated.

The subject to be treated may be a human being. As will be clear to theskilled person, the subject to be treated will in particular be a personsuffering from, or at risk of, the diseases and/or disorders mentionedherein. For example, the subject may be a person suffering from, or atrisk of, a disease and/or disorder related to IL-6 mediated signaling.

In particular, the polypeptides of the invention may be used incombination with other pharmaceutically active compounds or principlesthat are or can be used for the prevention and/or treatment of thediseases and disorders cited herein, as a result of which a synergisticeffect may or may not be obtained. Examples of such compounds andprinciples, as well as routes, methods and pharmaceutical formulationsor compositions for administering them will be clear to the clinician.

When two or more substances or principles are to be used as part of acombined treatment regimen, they can be administered via the same routeof administration or via different routes of administration, atessentially the same time or at different times (e.g. essentiallysimultaneously, consecutively, or according to an alternating regime).When the substances or principles are to be administered simultaneouslyvia the same route of administration, they may be administered asdifferent pharmaceutical formulations or compositions or part of acombined pharmaceutical formulation or composition, as will be clear tothe skilled person.

Also, when two or more active substances or principles are to be used aspart of a combined treatment regimen, each of the substances orprinciples may be administered in the same amount and according to thesame regimen as used when the compound or principle is used on its own,and such combined use may or may not lead to a synergistic effect.However, when the combined use of the two or more active substances orprinciples leads to a synergistic effect, it may also be possible toreduce the amount of one, more or all of the substances or principles tobe administered, while still achieving the desired therapeutic action.This may for example be useful for avoiding, limiting or reducing anyunwanted side-effects that are associated with the use of one or more ofthe substances or principles when they are used in their usual amounts,while still obtaining the desired pharmaceutical or therapeutic effect.

Definitions

Unless indicated or defined otherwise, all terms used have their usualmeaning in the art, which will be clear to the skilled person. Referenceis for example made to the standard handbooks, such as Sambrook et al.“Molecular Cloning: A Laboratory Manual” (2nd. Ed.), Vols. 1-3, ColdSpring Harbor Laboratory Press (1989); F. Ausubel et al. eds., “Currentprotocols in molecular biology”, Green Publishing and WileyInterscience, New York (1987); Lewin “Genes II”, John Wiley & Sons, NewYork, N.Y., (1985); Old et al. “Principles of Gene Manipulation: AnIntroduction to Genetic Engineering”, 2nd edition, University ofCalifornia Press, Berkeley, Calif. (1981); Roitt et al. “Immunology”(6th. Ed.), Mosby/Elsevier, Edinburgh (2001); Roitt et al. Roitt'sEssential Immunology, 10^(th) Ed. Blackwell Publishing, U K (2001); andJaneway et al. “Immunobiology” (6th Ed.), Garland SciencePublishing/Churchill Livingstone, New York (2005), as well as to thegeneral background art cited herein.

Unless indicated otherwise, all methods, steps, techniques andmanipulations that are not specifically described in detail can beperformed and have been performed in a manner known per se, as will beclear to the skilled person. Reference is for example again made to thestandard handbooks and the general background art mentioned herein andto the further references cited therein; as well as to for example thefollowing reviews: Presta 2006 (Adv. Drug Deliv. Rev. 58 (5-6): 640-56),Levin and Weiss 2006 (Mol. Biosyst. 2(1): 49-57), Irving et al. 2001 (J.Immunol. Methods 248(1-2): 31-45), Schmitz et al. 2000 (Placenta 21Suppl. A: S106-12), Gonzales et al. 2005 (Tumour Biol. 26(1): 31-43),which describe techniques for protein engineering, such as affinitymaturation and other techniques for improving the specificity and otherdesired properties of proteins such as immunoglobulins.

A nucleic acid sequence or amino acid sequence is considered to be “(in)essentially isolated (form)”—for example, compared to the reactionmedium or cultivation medium from which it has been obtained—when it hasbeen separated from at least one other component with which it isusually associated in said source or medium, such as another nucleicacid, another protein/polypeptide, another biological component ormacromolecule or at least one contaminant, impurity or minor component.In particular, a nucleic acid sequence or amino acid sequence isconsidered “essentially isolated” when it has been purified at least2-fold, in particular at least 10-fold, more in particular at least100-fold, and up to 1000-fold or more. A nucleic acid sequence or aminoacid sequence that is “in essentially isolated form” is preferablyessentially homogeneous, as determined using a suitable technique, suchas a suitable chromatographical technique, such as polyacrylamide-gelelectrophoresis.

When a nucleotide sequence or amino acid sequence is said to “comprise”another nucleotide sequence or amino acid sequence, respectively, or to“essentially consist of” another nucleotide sequence or amino acidsequence, this may mean that the latter nucleotide sequence or aminoacid sequence has been incorporated into the first mentioned nucleotidesequence or amino acid sequence, respectively, but more usually thisgenerally means that the first mentioned nucleotide sequence or aminoacid sequence comprises within its sequence a stretch of nucleotides oramino acid residues, respectively, that has the same nucleotide sequenceor amino acid sequence, respectively, as the latter sequence,irrespective of how the first mentioned sequence has actually beengenerated or obtained (which may for example be by any suitable methoddescribed herein). By means of a non-limiting example, when apolypeptide of the invention is said to comprise an immunoglobulinsingle variable domain, this may mean that said immunoglobulin singlevariable domain sequence has been incorporated into the sequence of thepolypeptide of the invention, but more usually this generally means thatthe polypeptide of the invention contains within its sequence thesequence of the immunoglobulin single variable domains irrespective ofhow said polypeptide of the invention has been generated or obtained.Also, when a nucleic acid or nucleotide sequence is said to compriseanother nucleotide sequence, the first mentioned nucleic acid ornucleotide sequence is preferably such that, when it is expressed intoan expression product (e.g. a polypeptide), the amino acid sequenceencoded by the latter nucleotide sequence forms part of said expressionproduct (in other words, that the latter nucleotide sequence is in thesame reading frame as the first mentioned, larger nucleic acid ornucleotide sequence).

By “essentially consist of” is meant that the immunoglobulin singlevariable domain used in the method of the invention either is exactlythe same as the polypeptide of the invention or corresponds to thepolypeptide of the invention which has a limited number of amino acidresidues, such as 1-20 amino acid residues, for example 1-10 amino acidresidues and preferably 1-6 amino acid residues, such as 1, 2, 3, 4, 5or 6 amino acid residues, added at the amino terminal end, at thecarboxy terminal end, or at both the amino terminal end and the carboxyterminal end of the immunoglobulin single variable domain.

In addition, the term “sequence” as used herein (for example in termslike “immunoglobulin sequence”, “variable domain sequence”,“immunoglobulin single variable domain sequence”, “VHH sequence” or“protein sequence”), should generally be understood to include both therelevant amino acid sequence as well as nucleic acid sequences ornucleotide sequences encoding the same, unless the context requires amore limited interpretation.

An amino acid sequence (such as a Nanobody, an antibody, a polypeptideof the invention, or generally an antigen binding protein or polypeptideor a fragment thereof) that can (specifically) bind to, that hasaffinity for and/or that has specificity for a specific antigenicdeterminant, epitope, antigen or protein (or for at least one part,fragment or epitope thereof) is said to be “against” or “directedagainst” said antigenic determinant, epitope, antigen or protein.

The term “specificity” refers to the number of different types ofantigens or antigenic determinants to which a particular antigen-bindingmolecule or antigen-binding protein (such as a Nanobody or a polypeptideof the invention) can bind. The specificity of an antigen-bindingprotein can be determined based on affinity and/or avidity. Theaffinity, represented by the equilibrium constant for the dissociationof an antigen with an antigen-binding protein (K_(D)), is a measure forthe binding strength between an antigenic determinant and anantigen-binding site on the antigen-binding protein: the lesser thevalue of the K_(D), the stronger the binding strength between anantigenic determinant and the antigen-binding molecule (alternatively,the affinity can also be expressed as the affinity constant (K_(A)),which is 1/K_(D)). As will be clear to the skilled person (for exampleon the basis of the further disclosure herein), affinity can bedetermined in a manner known per se, depending on the specific antigenof interest. Avidity is the measure of the strength of binding betweenan antigen-binding molecule (such as a Nanobody or polypeptide of theinvention) and the pertinent antigen. Avidity is related to both theaffinity between an antigenic determinant and its antigen binding siteon the antigen-binding molecule and the number of pertinent bindingsites present on the antigen-binding molecule. Typically,antigen-binding proteins (such as the amino acid sequences, Nanobodiesand/or polypeptides of the invention) will bind to their antigen with adissociation constant (K_(D)) of 10⁻⁵ to 10⁻¹² moles/liter or less, andpreferably 10⁻⁷ to 10⁻¹² moles/liter or less and more preferably 10⁻⁸ to10⁻¹² moles/liter (i.e. with an association constant (K_(A)) of 10⁵ to10¹² liter/moles or more, and preferably 10⁷ to 10¹² liter/moles or moreand more preferably 10⁸ to 10¹² liter/moles or more). Any K_(D) valuegreater than 10⁻⁴ mol/liter (or any K_(A) value lower than 10⁴liter/moles) is generally considered to indicate non-specific binding.Preferably, a monovalent immunoglobulin sequence of the invention willbind to the desired antigen with an affinity less than 500 nM,preferably less than 200 nM, more preferably less than 10 nM, such asless than 500 pM. Specific binding of an antigen-binding protein to anantigen or antigenic determinant can be determined in any suitablemanner known per se, including, for example, Scatchard analysis and/orcompetitive binding assays, such as radioimmunoassays (RIA), enzymeimmunoassays (EIA) and sandwich competition assays, and the differentvariants thereof known per se in the art; as well as the othertechniques mentioned herein.

The dissociation constant may be the actual or apparent dissociationconstant, as will be clear to the skilled person. Methods fordetermining the dissociation constant will be clear to the skilledperson, and for example include the techniques mentioned herein. In thisrespect, it will also be clear that it may not be possible to measuredissociation constants of more than 10⁻⁴ moles/liter or 10⁻³ moles/liter(e.g., of 10⁻² moles/liter). Optionally, as will also be clear to theskilled person, the (actual or apparent) dissociation constant may becalculated on the basis of the (actual or apparent) association constant(K_(A)), by means of the relationship [K_(D)=1/K_(A)].

The affinity denotes the strength or stability of a molecularinteraction. The affinity is commonly given as by the K_(D), ordissociation constant, which has units of mol/liter (or M). The affinitycan also be expressed as an association constant, K_(A), which equals1/K_(D) and has units of (mol/liter)⁻¹ (or M⁻¹). In the presentspecification, the stability of the interaction between two molecules(such as an amino acid sequence, Nanobody or polypeptide of theinvention and its intended target) will mainly be expressed in terms ofthe K_(D) value of their interaction; it being clear to the skilledperson that in view of the relation K_(A)=1/K_(D), specifying thestrength of molecular interaction by its K_(D) value can also be used tocalculate the corresponding K_(A) value. The K_(D)-value characterizesthe strength of a molecular interaction also in a thermodynamic sense asit is related to the free energy (DG) of binding by the well-knownrelation DG=RT·ln(K_(D)) (equivalently DG=−RT·ln(K_(A))), where R equalsthe gas constant, T equals the absolute temperature and ln denotes thenatural logarithm.

The K_(D) for biological interactions which are considered meaningful(e.g. specific) are typically in the range of 10⁻¹⁰M (0.1 nM) to 10′M(10000 nM). The stronger an interaction is, the lower is its K_(D).

The K_(D) can also be expressed as the ratio of the dissociation rateconstant of a complex, denoted as k_(off), to the rate of itsassociation, denoted k_(on) (so that K_(D)=k_(off)/k_(on) andK_(A)=k_(on)/k_(off)). The off-rate k_(off) has units s⁻¹ (where s isthe SI unit notation of second). The on-rate k_(on) has units M⁻¹s⁻¹.The on-rate may vary between 10² M⁻¹s⁻¹ to about 10² M⁻¹s⁻¹, approachingthe diffusion-limited association rate constant for bimolecularinteractions. The off-rate is related to the half-life of a givenmolecular interaction by the relation t_(1/2)=ln(2)/k_(off). Theoff-rate may vary between 10⁻⁶ s⁻¹ (near irreversible complex with at_(1/2) of multiple days) to 1 s⁻¹ (t_(1/2)=0.69 s).

The affinity of a molecular interaction between two molecules can bemeasured via different techniques known per se, such as the well-knownsurface plasmon resonance (SPR) biosensor technique (see for exampleOber et al. 2001, Intern. Immunology 13: 1551-1559) where one moleculeis immobilized on the biosensor chip and the other molecule is passedover the immobilized molecule under flow conditions yielding k_(on),k_(off) measurements and hence K_(D) (or K_(A)) values. This can forexample be performed using the well-known Biacore instruments.

It will also be clear to the skilled person that the measured K_(D) maycorrespond to the apparent K_(D) if the measuring process somehowinfluences the intrinsic binding affinity of the implied molecules forexample by artifacts related to the coating on the biosensor of onemolecule. Also, an apparent K_(D) may be measured if one moleculecontains more than one recognition sites for the other molecule. In suchsituation the measured affinity may be affected by the avidity of theinteraction by the two molecules.

Another approach that may be used to assess affinity is the 2-step ELISA(Enzyme-Linked Immunosorbent Assay) procedure of Friguet et al. 1985 (J.Immunol. Methods 77: 305-19). This method establishes a solution phasebinding equilibrium measurement and avoids possible artifacts relatingto adsorption of one of the molecules on a support such as plastic.

However, the accurate measurement of K_(D) may be quite labor-intensiveand as consequence, often apparent K_(D) values are determined to assessthe binding strength of two molecules. It should be noted that as longall measurements are made in a consistent way (e.g. keeping the assayconditions unchanged) apparent K_(D) measurements can be used as anapproximation of the true K_(D) and hence in the present document K_(D)and apparent K_(D) should be treated with equal importance or relevance.

Finally, it should be noted that in many situations the experiencedscientist may judge it to be convenient to determine the bindingaffinity relative to some reference molecule. For example, to assess thebinding strength between molecules A and B, one may e.g. use a referencemolecule C that is known to bind to B and that is suitably labelled witha fluorophore or chromophore group or other chemical moiety, such asbiotin for easy detection in an ELISA or FACS (Fluorescent activatedcell sorting) or other format (the fluorophore for fluorescencedetection, the chromophore for light absorption detection, the biotinfor streptavidin-mediated ELISA detection). Typically, the referencemolecule C is kept at a fixed concentration and the concentration of Ais varied for a given concentration or amount of B. As a result an IC₅₀value is obtained corresponding to the concentration of A at which thesignal measured for C in absence of A is halved. Provided K_(D ref), theK_(D) of the reference molecule, is known, as well as the totalconcentration c_(ref) of the reference molecule, the apparent K_(D) forthe interaction A-B can be obtained from following formula:K_(D)=IC₅₀/(1+C_(ref)/K_(D ref)). Note that if c_(ref)<<K_(D ref),K_(D)≈IC₅₀. Provided the measurement of the IC₅₀ is performed in aconsistent way (e.g. keeping c_(ref) fixed) for the binders that arecompared, the strength or stability of a molecular interaction can beassessed by the IC₅₀ and this measurement is judged as equivalent toK_(D) or to apparent K_(D) throughout this text.

The half-life of an amino acid sequence, compound or polypeptide of theinvention can generally be defined as the time taken for the serumconcentration of the amino acid sequence, compound or polypeptide to bereduced by 50%, in vivo, for example due to degradation of the sequenceor compound and/or clearance or sequestration of the sequence orcompound by natural mechanisms. The in vivo half-life of an amino acidsequence, compound or polypeptide of the invention can be determined inany manner known per se, such as by pharmacokinetic analysis. Suitabletechniques will be clear to the person skilled in the art, and may forexample generally involve the steps of suitably administering to awarm-blooded animal (i.e. to a human or to another suitable mammal, suchas a mouse, rabbit, rat, pig, dog or a primate, for example monkeys fromthe genus Macaca (such as, and in particular, cynomolgus monkeys (Macacafascicularis) and/or rhesus monkeys (Macaca mulatta)) and baboon (Papioursinus)) a suitable dose of the amino acid sequence, compound orpolypeptide of the invention; collecting blood samples or other samplesfrom said animal; determining the level or concentration of the aminoacid sequence, compound or polypeptide of the invention in said bloodsample; and calculating, from (a plot of) the data thus obtained, thetime until the level or concentration of the amino acid sequence,compound or polypeptide of the invention has been reduced by 50%compared to the initial level upon dosing. Reference is for example madeto the Experimental Part below, as well as to the standard handbooks,such as Kenneth et al. 1996 (Chemical Stability of Pharmaceuticals: AHandbook for Pharmacists and Peters et al, Pharmacokinete analysis: APractical Approach). Reference is also made to Gibaldi and Perron 1982(Pharmacokinetics, published by Marcel Dekker, 2nd Rev. edition).

As will also be clear to the skilled person (see for example pages 6 and7 of WO 04/003019 and in the further references cited therein), thehalf-life can be expressed using parameters such as the t½-alpha,t½-beta and the area under the curve (AUC). In the presentspecification, an “increase in half-life” refers to an increase in anyone of these parameters, such as any two of these parameters, oressentially all three these parameters. As used herein “increase inhalf-life” or “increased half-life” in particular refers to an increasein the t½-beta, either with or without an increase in the t½-alphaand/or the AUC or both.

A polypeptide of the invention is said to “reduce levels of a marker(such as e.g. CRP, ESR, fibrinogen or serum amyloid A) by x % or more”or to “reduce levels of a marker by x % or more compared to baseline(i.e. pre-treatment or normal) levels” if administration of thepolypeptide of the invention to the subject results in a reduction ofthe levels of said marker of x % compared to the levels before thetreatment or compared to normal levels. In this case the levels of themarker in the treated subject are “decreased by x % or more” or“decreased by x % or more compared to baseline (i.e. pre-treatment ornormal) levels”. This means that the levels of the marker in the treatedsubject will be x % lower compared to the levels of the marker beforetreatment or compared to the normal levels of the marker. For example,if a polypeptide of the invention is said to “reduce serum levels of CRPby 30% or more” or to “reduce serum levels of CRP by 30% or morecompared to baseline (pre-treatment or normal) levels”, the serum levelsof CRP in the treated subject will be 30% lower compared to the levelsof CRP before treatment or compared to the normal levels of CRP. In thiscase the serum levels of CRP in the treated subject are “decreased by30% or more” or “decreased by 30% or more compared to baseline (i.e.pre-treatment or normal) levels”.

A polypeptide of the invention is said to “maintain levels of a marker(such as e.g. CRP, ESR, fibrinogen or serum amyloid A) at x % or morereduction” or “maintain levels of a marker (such as e.g. CRP, ESR,fibrinogen or serum amyloid A) at x % or more reduction compared tobaseline levels” if the reduced levels of the marker are maintained x %lower compared to the levels of the marker before treatment or comparedto the normal levels of the marker. In this case the levels of themarker in the treated subject are “maintained at x % or more(reduction)” or “maintained at x % or more (reduction) compared tobaseline (i.e. pre-treatment or normal) levels”. This means that thelevels of the marker in the treated subject continue to be x % lowercompared to the levels of the marker before treatment or compared to thenormal levels of the marker. For example a polypeptide of the inventionis said to maintain serum levels of CRP “at 30% or more reduction” ifthe reduced levels of serum CRP are maintained 30% or more lowercompared to the serum CRP levels before treatment or compared to thenormal serum levels of CRP. In this case the serum levels CRP in thetreated subject are “maintained at 30% or more (reduction)” or“maintained at 30% or more (reduction) compared to baseline (i.e.pre-treatment or normal) levels”. This means that the serum levels ofCRP in the treated subject continue to be 30% lower compared to theserum levels of CRP before treatment or compared to the normal serumlevels of CRP.

The Figures, and the Experimental Part/Examples are only given tofurther illustrate the invention and should not be interpreted orconstrued as limiting the scope of the invention and/or of the appendedclaims in any way, unless explicitly indicated otherwise herein.

EXAMPLES List of Abbreviations

-   ADA Anti-drug antibody-   bw bodyweight-   C Concentration-   CL Clearance-   CLi Inter-compartmental flow-   CL_(IL6R) Target mediated clearance-   CL_(non-IL6R) Linear clearance-   CRP C-reactive protein-   DRF Dose range finding-   ESR Erythrocyte sedimentation rate-   h Hour-   i.e. Id est-   i.v. Intravenous-   IC50 Concentration at which half of maximal effect is observed-   Imax Maximal effect-   kin Zero order synthesis rate constant-   km Substrate concentration when the velocity of the reaction is ½    Vmax-   kout First order elimination rate constant-   MAD Multiple ascending dose-   min Minutes-   MTD Maximum tolerated dose-   n Sigmoidicity factor-   nM Nanomolar-   PD Pharmacodynamic(s)-   PK Pharmacokinetic(s)-   Q2W Every 2 weeks-   Q4W Every 4 weeks-   Q8W Every 8 weeks-   R Response-   SAA Serum amyloid A-   SAD Single ascending dose-   SAEs Serious adverse events-   sIL-6R Soluble interleukin 6 receptor-   Vc Central volume-   Vdss Volume of distribution at steady-state-   Vmax Maximum velocity-   Vt Peripheral volume    Determination of sIL-6R (=Total sIL-6R) Levels in Serum

The method to determine total sIL-6R concentrations in human plasma wasan in-house developed sandwich enzyme-linked immunosorbent assay(ELISA). A non-neutralizing anti-IL-6R monoclonal antibody (B-N12) wasfirst coated on a 96 well Maxisorp plate by adsorption, after whichexcess binding sites were blocked with PBS-1% casein. Calibrators andvalidation samples were prepared from stock solutions of recombinanthuman sIL-6R using cynomolgus monkey sIL-6R free plasma and diluent(PBS/0.1% casein/0.05% Tween20 supplemented with 100 ng/mL IL6R304 toovercome drug interference). After transfer of the calibrators andsamples onto the plate, detection was performed with a biotinylated goatanti-human IL-6R antibody and horseradish peroxidase (HRP)-labeledstreptavidin. In the presence of H₂O₂, the peroxidase catalyzes achemical reaction with the enhanced soluble3,3′,5,5′-tetramethylbenzidine (esTMB) resulting in a colorimetricchange. After stopping the colorimetric reaction with 1M HCl, theoptical density was measured at a wavelength of 450 nm in a platespectrophotometer.

Determination of IL-6 Levels in Serum

For determining IL-6 concentrations in human serum, the commerciallyavailable “Human IL-6 Quantiglo ELISA Kit” from R&D Systems was used(cat# Q6000B). The assay was performed as described in themanufacturer's instructions. Assay Diluent RD1-83 was supplemented with10 μg/mL IL6R304 before use to overcome IL-6R interference.

Determination of CRP Levels

For determining CRP concentrations in human serum, the commerciallyavailable “IMMAGE Immunochemistry Systems C-Reactive Protein (KitRecorder #447280)” from Beckman Coulter Inc. (Brea, Calif., US) wasused. The assay was performed as described in the manufacturer'sinstructions.

Determination of ESR Levels

For determining ESR levels in serum, the following commerciallyavailable assays were used: the Greiner ESR tube or thePreanalytics—VACUETTE® Evacuated Collection Tubes (Greiner Bio-One GmbH,Kremsmuenster, Austria), the Sarstedt Sediplus® 2000 (Sarstedt,Nümbrecht, Germany), or the Becton Dickinson Seditainer (BectonDickinson, Franklin Lakes, N.J., USA).

Determination of Fibrinogen Levels

For determining fibrinogen levels in serum, the following commerciallyavailable assays were used: the STA® Fibrinogen 5 or the STA® Compact(Stago, Asniéres sur Seine, France), the ACL TOP® 500 CTS (BeckmanCoulter Inc., Brea, Calif., US), or the Ceveron® alpha (TC technoclone,Vienna, Austria).

Determination of Serum Amyloid A Levels

The method to determine serum amyloid A was a sandwich enzyme-linkedimmunosorbent assay (ELISA). A highly purified monoclonal antibodyagainst human SAA was coated onto the wells of the microtiter strip.Standards of known human SAA content, controls and unknown samples werepipetted into the coated wells, followed by the addition of biotinylatedsecond monoclonal antibody. After washing, Streptavidin-Peroxidase wasadded. After a second incubation and washing to remove all unboundenzyme, a substrate solution (TMB) was added. The intensity of theobtained color was directly proportional to the concentration of humanSAA present in the original specimen.

Example 1: Toxicology Studies with IL6R304

In a single dose toxicity study IL6R304 was administered to malecynomolgus monkeys as single i.v. doses of 0, 1, 5, 10, 25, 100 mg/kgb.w IL6R304. Blood samples for pharmacokinetic (PK), anti-drug antibody(ADA), and pharmacodynamic (PD) analysis purposes were collected fromall animals at pre-dose and at selected time points post-dose. Sampleswere analysed for PK, PD and ADA purposes using validated methods.

Toxicokinetic samples were taken at 5 min, 0.5, 3, 8 h, day 1, 2, 4, 7,14, 21, 28, 35, 49, 63 and 77 days post-dose.

Example 2: Preclinical Data

Pharmacokinetic (PK) and pharmacodynamic (PD) modeling was performed ondata generated in a single dose toxicity study with IL6R304 in thecynomolgus monkey as described in Example 1.

2.1 Pharmacokinetic Modeling of Cynomolgus Monkey IL6R304 PlasmaConcentrations

An open two-compartmental pharmacokinetic model with linear and anon-linear clearance from the central compartment captured thenon-linear pharmacokinetic behavior of IL6R304 in the cynomolgus monkey.

The linear clearance mechanism is likely related to the non-saturable,and non-target mediated removal of IL6R304 and corresponds to the slowand non-specific proteolytic degradation of IL6R304. The non-linear andtarget-mediated clearance process is a saturable clearance mechanism;most probably representing binding of IL6R304 to membrane bound IL6-Rand subsequent internalization and clearance.

All available individual plasma concentration data after a single i.v.dose were used for building the pharmacokinetic model (WinNonlinProfessional Software Version 5.1 (Pharsight Corporation, Mountain ViewCalif., USA)).

At low IL6R304 concentrations (C<<<K_(m)) the contribution of theIL-6R-mediated clearance (CL_(IL6-R)) is predominant and equalsV_(max)/K_(m). At high IL6R304 concentrations (C>>>Km), theIL-6R-mediated clearance pathway becomes saturated and will proceed atthe maximum mass turnover (i.e. V_(max)). Consequently, the overallclearance (CL) is dominated by the linear, non-IL-6R mediated pathway(CL_(NON-IL6R)).

The estimated PK parameters of IL6R304 in the cynomolgus monkey arelisted in Table B-1. All parameters were estimated with sufficientprecision.

TABLE B-1 Pharmacokinetic parameters of IL6R304 in the cynomolgusmonkey. Parameter Estimate % CV V_(c) (mL/kg) 48.5 4.0 V_(t) (mL/kg)47.6 6.5 V_(dss) (mL/kg) 96.1 CL_(NON-IL6R) (mL/h · kg) 0.244 3.5 CL_(i)(mL/h · kg) 1.18 18.7 V_(max) (μg/h · kg) 2.498 11.7 K_(m) (μg/mL) 0.92435.0 CL_(IL6R) (mL/h · kg) 2.702.2 Semi-Mechanistic PK/PD Modeling (Cynomolgus Monkey IL6R304 PlasmaConcentrations and Serum sIL-6R Concentrations)

In order to describe the pharmacodynamic effect of IL6R304 in amathematical model sIL-6R was selected as a robust and preciselyquantifiable biomarker which correlates to the concentration of activedrug. The influence of IL6R304 administration on total sIL-6R levels canbe explained by direct binding of IL6R304 to the receptor: the complexstays in circulation via the half-life extension moiety of IL6R304 (i.e.albumin binding). As the measurable changes in total sIL-6Rconcentrations follow a time-delayed kinetic, an indirect response modelbest describes the PK/PD relationship and was used to describe theeffect of i.v. administered IL6R304 on the accumulation ofsIL-6R/IL6R304 complex levels.

The model describes a drug response that results from the inhibition ofthe elimination of sIL-6R when bound to IL6R304. In this indirectresponse model, the rate of change of total sIL-6R-IL6R304 complex(Response R) is described by:

$\frac{dR}{dt} = {{Kin} - {{Kout}*\left\lbrack {1 - {{Imax}*\frac{C^{n}}{{{IC}\; 50^{n}} + C^{n}}}} \right\rbrack*R}}$

With Kin, the zero order synthesis rate; R, the total sIL-6R; Imax, themaximum inhibition; C, the IL6R304 plasma concentration; IC50, theIL6R304 concentration at which half of the maximum effect is observed;n, the dose-response shape factor; and Kout, the first order eliminationrate constant of sIL-6R.

All available total sIL-6R data from the single dose toxicity studyafter i.v. administration were used to build the PK/PD model (WinNonlinProfessional Software Version 5.1, Pharsight Corporation, Mountain ViewCalif., USA) using the pharmacokinetic function as input function forthe indirect response PK/PD model.

The pharmacodynamic effect of i.v. administered IL6R304 on thephysiological turnover of serum sIL-6R in the monkey were adequatelycaptured using a semi-mechanistic PK/PD model (indirect response model).

IL6R304 was able to almost completely inhibit the elimination of sIL-6Rvia the primary pathway (I_(max)=97%), and at this maximum effect levelthe calculated k_(out) and corresponding half-life of sIL-6R was similarto that of cynomolgus monkey serum albumin. With an estimated IC₅₀ of 68ng/mL or 2.64 nM, IL6R304 was shown to be a potent inhibitor of theelimination of non-complexed sIL-6R in cynomolgus monkey.

The estimated pharmacodynamic parameters of IL6R304, in cynomolgusmonkey, are listed in Table B-2. All parameters were estimated with asufficient degree of precision as indicated by CV % values below 25%.

TABLE B-2 Pharmacodynamic parameters of IL6R304 in cynomolgus monkeys.Parameter Estimate % CV K_(in) (ng/mL · h) 2.56 7.1 R₀ (ng/mL) 21.8 4.8I_(max) (%) 0.974 0.4 IC₅₀ (μg/mL) 0.068 24.4 IC₅₀ (nM) 2.64 n 0.87 10.5

Example 3: Scaling to Human: Simulation of IL6R304 PK/PD in Humans

The PK/PD model developed to describe the temporal profile of IL6R304concentrations and corresponding serum sIL-6R levels in the cynomolgusmonkey was scaled to human to assist in the dose selection of the firstin human study.

To simulate the temporal profile of IL6R304 in human after i.v. bolus,volumes of distribution in the central (V_(t)) and peripheral (V_(t))compartments, the inter-compartmental flow (CL_(i)) and the linearclearance (CL) were scaled using standard allometric factors (1 forV_(c) and V_(t), 0.75 for CL_(i) and CL) (Boxenbaum and DiLea 1995,First-time-in-human dose selection: allometric thoughts and perspectivesJ. Clin. Pharmacol. 35: 957-966). For the nonlinear clearance, dependingon the parameters V_(max) and K_(m), the V_(max) was assumed to be equalas that reported for tocilizumab (TCZ) (as IL6R304 and TCZ bind to thesame target with similar potency) (in-house data), and the K_(m) wasassumed to be equal to values obtained for cynomolgus monkey, assuggested by an in-house model comparing TCZ and IL6R304 behavior andindicating in cynomolgus monkey for IL6R304 a K_(m) similar to that ofTCZ, reported as similar to that in human.

The PK parameters used for the simulation of the IL6R304 plasmaconcentration-time profiles are listed in Table B-3.

TABLE B-3 Allometrically scaled pharmacokinetic parameters of IL6R304 inhumans. Parameter (Units) V_(c) (mL/kg) 48.5 V_(t) (mL/kg) 47.6CL_(NON-IL6R) (mL/h · kg) 0.0918 CL_(i) (mL/h · kg) 0.446 V_(max) (μg/h· kg) 4.46 K_(m) (μg/mL) 0.924

Consequently, the predicted IL6R304 plasma levels were used in the PK/PDmodel developed in monkey to describe the temporal profile of totalsIL-6R in human. In this model system parameters (baseline (R0) andkout) for human were derived from the literature (Kyrtsonis M. C.,Desoussis G., Zervas C., Perifanis V., Baxevanis C., Stamatelou M.,Maniatis A. 1996, Soluble interleukin-6 receptor (sIL-6R), a newprognostic factor in multiple myeloma. British Journal of hematology 93(2): 398-400; Levi M., Charoin J. E., Frey N., Delor I., Jacqmin P.2009, A mechanistic target mediated drug disposition (TMDD) model isrequired to correctly estimate the bioavailability of a subcutaneousformulation of Tocilizumab (TCZ), a monoclonal antibody with non-linearkinetics. American Conference on Pharmacometrics (ACoP) 2009,Mashantucket 2009), whereas the drug specific parameters IC50, I_(max)and n were assumed equal to those determined in the monkey.

In Table B-4, the PD parameters used for the simulation of the IL6R304serum sIL-6R concentration-time profiles are listed.

TABLE B-4 Pharmacodynamic parameters of IL6R304 used in the PK/PDsimulations of serum sIL-6R concentrations. Parameter (Units) K_(out)(h⁻¹) 0.0625 R₀ (ng/mL) 27.7 I_(max) (%) 0.974 IC₅₀ (μg/mL) 0.068 n 0.87

Simulated PD profiles indicated a dose-dependent increase of serumsIL-6R after a single i.v. dose with IL6R304, consistent with theindirect response model describing inhibition of serum sIL-6Relimination.

Example 4: Clinical Data Clinical Study Design

A multi-center, randomized, double-blind, placebo-controlled,dose-escalation, phase I/II study in patients with RA, consisting of asingle ascending dose (SAD) part and a multiple ascending dose (MAD)part, was conducted.

The SAD part consisted of 1 group of 4 (2+2) patients and 3 groups of 8(6+2) patients each. In the first group 2 patients received a singleintravenous (iv) dose of IL6R304 (0.3 mg/kg) and 2 patients received asingle iv dose of placebo. As of the second group, 6 patients received asingle intravenous (iv) dose of IL6R304 (1, 3, 6 mg/kg) and 2 patientsreceived a single iv dose of placebo. At the end of the SAD part aninterim PK/PD analysis was done to confirm the adequacy of theanticipated doses and dosing regimens to be used in the MAD part of thestudy.

The MAD part consists of 3 groups (Groups 6-8) of 12 patients each. Ineach group, 10 patients receive multiple iv doses of IL6R304 and 2patients receive multiple iv doses of placebo. In the original protocol,the following dose levels were considered: 1 mg/kg Q2W (every twoweeks), 3 mg/kg Q2W, 6 mg/kg Q4W (every four weeks) for 12 weeks oftreatment.

Blood samples are planned to be collected for determination of IL6R304levels at pre-dose, end of injection/infusion, 8 h, and Day 2, 3, 4, 5,8, 15, 29, 36 and 57 post-dose. The same time schedule is planned forbiomarkers (CRP, ESR, SAA, fibrinogen, IL-6, sIL-6R, TNF-α, IL-1β andIFN-γ) determination, except the end of injection/infusion and the Day 5time-points.

An interim PK/PD analysis is performed at the end of the SAD part of thestudy on the IL6R304 and the sIL-6R data, as their expected profilesafter multiple dose were considered most critical for the dose/dosingregimen selection for the second part of the study.

Preliminary Results from SAD Study

C-Reactive Protein (CRP)

An overview of the C-Reactive Protein (CRP) changes from baseline duringthe SAD study for the different treatment groups is given in FIG. 4 andTable B-5. A rapid and dose-proportional decrease from baseline wasobserved for this biomarker. The longest suppression (more than 57 days)was observed for the 6 mg/kg treatment group. This duration of the CRPreduction supports Q4W (every 4 weeks) and Q8W (every 8 weeks) dosing.The largest effect on CRP and disease activity score was obtained at 6mg/kg.

TABLE B-5 CRP values (relative changes from baseline (SD)) Time afterdosing Placebo (N = 8) 0.3 mg/kg 1 mg/kg 3 mg/kg 6 mg/kg DAY1_8H N 8 2 66 6 %  −3.3 (17.25) 4.7 (6.65)  −5.4 (14.16) −17.8 (13.33) −10.9 (12.73)DAY2_24H N 8 2 6 6 6 % −13.0 (15.29)  5.6 (30.12) −18.3 (8.72)  −34.8(9.69)  −26.9 (12.22) DAY3_48H N 8 2 6 5 6 % −18.2 (16.96) −37.7(31.50)   −40.8 (8.52)  −57.7 (15.80) −45.0 (9.84)  DAY4_72H N 8 2 6 5 6% −11.1 (27.33) −59.7 (19.10)   −36.3 (23.93) −68.6 (16.19) −59.2(9.81)  DAY 8 N 8 2 6 6 6 % −18.9 (28.24) −60.2 (41.56)   −49.1 (32.19)−66.3 (30.00) −63.4 (23.15) DAY 15 N 8 2 6 5 6 %   2.2 (42.18) 145.1(28.74)  −52.7 (23.48) −72.6 (24.49) −43.5 (72.19) DAY 29 N 8 2 6 5 6 %−12.6 (26.31) 51.9 (29.99)   23.2 (53.60) −73.5 (22.34) −62.8 (27.30)DAY 36 N 8 2 6 5 6 %   1.5 (51.68) 39.7 (34.46)   42.2 (73.16)   11.3(144.98) −59.7 (37.94) DAY 57 N 8 2 6 5 6 %   11.1 (60.11)  84.5(119.49)   5.1 (27.92)  −3.9 (52.21) −52.1 (21.86) FOLLOW UP N 8 2 6 6 6%   15.2 (57.60) 39.0 (37.36)   4.0 (17.40) −14.9 (50.98) −14.8 (37.85)

Following IL6R304 administration, CRP levels declined rapidly from 8hours post-dose (the first post-dose sampling time point). The maximumreduction in mean CRP levels varied between 74% and 53% of baselineacross the dose range studied (60% on Day 8 for 0.3 mg/kg, 53% on Day 15for 1 mg/kg, 74% on Day 29 for 3 mg/kg, 63% on Day 8 for 6 mg/kg).

There was no clear dose response with respect to magnitude of CRPdecrease, but a dose-related increase in the duration of reduction wasapparent.

The corresponding CRP levels for the placebo group did not show aclinically meaningful change from baseline.

Erythrocytes Sedimentation Rate (ESR)

An overview of the ESR changes from baseline during the SAD study forthe different treatment groups is given in Table B-6.

Following IL6R304 administration, the ESR values declined starting from48 hours post-dose onwards. The maximum decrease in mean ESR valuesvaried between 82% and 32% of baseline across the dose range studied(32% on Day 4 for 0.3 mg/kg, 59% on Day 8 and 59% on Day 15 for 1 mg/kg,82% on Day 15 for 3 mg/kg, 69% on Day 57 for 6 mg/kg).

A dose-dependent increase in the duration of reduction was apparent. TheESR values returned to baseline at Day 57 for all dose levels except the6 mg/kg group.

The corresponding ESR values for the placebo group did not show aclinically meaningful change from baseline.

TABLE B-6 Erythrocytes Sedimentation Rate (relative changes frombaseline (SD)) Time after dosing Placebo (N = 8) 0.3 mg/kg 1 mg/kg 3mg/kg 6 mg/kg DAY1_8H N 8 2 6 6 6 % 23.4 (44.97)   2.5 (21.19) −20.2(33.01) −14.5 (25.31)   6.5 (19.90) DAY2_24H N 8 2 6 6 6 % 11.4 (47.08) −6.9 (25.53) −12.5 (59.29) −15.1 (23.32) −10.1 (12.95) DAY3_48H N 8 2 65 6 %  6.1 (45.79)   7.1 (10.10)   0.5 (87.12) −23.5 (14.08) −35.4(33.89) DAY4_72H N 8 2 6 5 6 % 23.4 (24.95) −32.2 (7.44)  −43.5 (23.08)−43.4 (14.18) −28.0 (18.28) DAY 8 N 8 2 6 6 6 % 24.3 (54.28) −26.1(19.22) −58.7 (17.16) −67.5 (13.45) −60.2 (30.95) DAY 15 N 8 2 6 5 6 %58.0 (81.98) −26.1 (19.22) −58.8 (26.26) −82.4 (8.10)  −53.8 (32.05) DAY29 N 8 2 6 5 6 % 39.7 (82.42)   5.6 (16.77)   8.3 (45.03) −81.2 (9.40) −60.3 (27.72) DAY 36 N 8 2 6 5 6 % 47.6 (81.74)  18.1 (9.82)   14.7(60.99) −70.8 (16.36) −66.3 (21.70) DAY 57 N 8 2 6 5 6 % 40.9 (68.08) 15.0 (3.51)   23.6 (40.51)   3.0 (18.99) −69.3 (19.63) FOLLOW UP N 8 26 6 6 %  82.6 (118.05)  −6.9 (25.53)   1.3 (56.89) −17.8 (30.31)  −6.5(40.59)

Fibrinogen

An overview of the fibrinogen changes from baseline during the SAD studyfor the different treatment groups is given in Table B-7.

Overall, a decrease from baseline in fibrinogen levels was observedfollowing IL6R304 administration from 8 hours post-dose (the firstpost-dose sampling time point) for all dose levels. The maximum decreasein mean fibrinogen levels varied between 52% and 32% from baselineacross the dose range studied (32% on Day 8 for 0.3 mg/kg, 42% on Day 15for 1 mg/kg, 52% on Day 29 for 3 mg/kg, 37% on Day 15 for 6 mg/kg).

A dose-dependent increase in the duration of reduction was apparent.Fibrinogen levels returned to baseline at Day 57 for all dose levelsexcept 6 mg/kg group.

The corresponding fibrinogen levels for the placebo group did not show aclinically relevant change from baseline.

TABLE B-7 Fibrinogen (relative changes after baseline (SD)) Time afterdosing Placebo (N = 8) 0.3 mg/kg 1 mg/kg 3 mg/kg 6 mg/kg DAY1_8 N 8 2 66 6 % −2.7 (6.00)   −3.2 (9.69)   −11.3 (4.30) −12.4 (5.38)  −4.5 (4.75)DAY2_24H N 8 2 6 6 6 % 7.8 (8.80)  −1.5 (22.73)   −7.0 (6.58) −9.6(9.27)  −2.3 (11.83) DAY3_48H N 8 2 6 5 6 % −0.5 (9.75)   −6.1 (19.40) −17.9 (4.75) −16.0 (16.42)  −7.0 (15.64) DAY4_72H N 8 2 6 5 6 % 0.7(5.28)  −16.0 (26.28)   −15.7 (7.39) −16.9 (29.86) −19.1 (14.72) DAY 8 N8 2 6 6 6 % 2.1 (9.85)  −31.6 (22.03)   −35.1 (4.75) −38.6 (15.66) −28.5(16.49) DAY 15 N 8 2 6 5 6 % 4.1 (18.37) 11.3 (28.88) −41.9 (6.60) −49.9(16.79) −36.5 (21.69) DAY 29 N 8 2 6 5 6 % 3.6 (19.40) 12.6 (29.61)   0.9 (20.06) −52.1 (14.58) −35.0 (22.27) DAY 36 N 8 2 6 5 6 % 4.0(15.65) 31.1 (37.50)   12.5 (17.87) −34.3 (22.68) −34.3 (23.42) DAY 57 N8 2 6 5 6 % 6.3 (24.63) 22.0 (14.36)    1.1 (20.28) −8.6 (7.24) −30.4(15.10) FOLLOW UP N 8 2 6 6 6 % 5.4 (19.43) −0.5 (13.56)    2.4 (6.36) −5.5 (30.33)   0.7 (25.08)

Serum Amyloid A (SAA)

An overview of the serum amyloid A changes from baseline during the SADstudy for the different treatment groups is given in Table B-8.

Overall, a decrease from baseline in SAA concentration was observedfollowing IL6R304 administration for all dose levels from 8 hourspost-dose. The maximum decrease in mean SAA levels varied between 74%and 58% of baseline across the dose range studied (69% on Day 8 for 0.3mg/kg, 60% on Day 4 for 1 mg/kg, 74% on Day 15 for 3 mg/kg, 58% on Day 8for 6 mg/kg).

A dose-dependent increase in the duration of reduction of SAA levels wasapparent.

The SAA concentrations of the placebo-treated subjects increased abovebaseline at most time points.

TABLE B-8 Serum amyloid A (relative changes from baseline (SD)) Timeafter dosing Placebo (N = 8) 0.3 mg/kg 1 mg/kg 3 mg/kg 6 mg/kg DAY1_8H N8 2 6 6 6 % −4.3 (18.69)  −11.9 (16.26) −12.5 (18.77) −29.7 (24.18) −7.9 (11.10) DAY2_24H N 8 2 6 6 6 % −10.3 (24.86)    −8.8 (26.04) −30.2(25.81) −28.8 (17.49) −25.0 (14.67) DAY3_48H N 7 2 6 5 6 % −2.8 (48.38) −42.9 (29.44) −51.4 (25.35) −60.6 (16.41) −38.5 (44.93) DAY4_72H N 7 2 65 6 % 10.7 (66.30) −65.9 (28.80) −60.3 (21.63) −58.6 (31.51) −42.5(53.67) DAY 8 N 8 2 6 6 6 % 38.1 (93.77) −69.1 (38.69) −44.4 (68.57)−68.1 (30.70) −58.2 (24.40) DAY 15 N 8 2 6 5 6 % 39.8 (86.52)  144.5(87.78) −48.6 (35.78) −73.6 (21.42)  −4.5 (143.16) DAY 29 N 8 2 6 5 6 %22.3 (73.33)   81.4 (27.43)   16.2 (41.97) −67.4 (25.90) −43.7 (64.10)DAY 36 N 8 2 6 5 6 % 24.4 (56.16)  46.0 (7.09)   18.9 (54.92)   17.4(163.79) −30.1 (31.49) DAY 57 N 8 2 6 5 6 %  78.2 (164.35)   71.4(41.68) −10.5 (38.20)  −6.8 (71.87)   17.9 (92.56) FOLLOW UP N 8 2 6 6 6%  76.1 (114.40)   14.1 (30.62)   27.6 (58.82)  −6.4 (59.62)  −7.3(62.82)

Interleukin-6

The changes in IL-6 levels (pg/ml) during the SAD study for thedifferent treatment groups is given in FIG. 6.

Following IL6R304 administration, mean IL-6 plasma concentrationsincreased from 8 hours post-dose up to the follow-up visit for allIL6R304 dose levels.

The maximum increase from baseline in mean levels varied between 11,076%and 216% of baseline across the dose range studied (216% on Day 4 for0.3 mg/kg, 2,054% on Day 15 for 1 mg/kg, 11,076% on Day 3 for 3 mg/kg[note: 1 subject had a very high value of 48,419], 746% on Day 15 for 6mg/kg).

As expected, mean IL-6 levels of the placebo group did not show aclinically relevant change from baseline.

Soluble Interleukin-6 Receptor (sIL-6R)

The changes in sIL-6R levels (ng/ml) during the SAD study for thedifferent treatment groups is given in FIG. 7.

Following IL6R304 administration, mean sIL-6R concentrations increasedfrom 8 hours post-dose, with a dose-dependent increase in the durationof increase in sIL-6R levels. A dose-related effect of IL6R304 wasobserved on the maximal sIL-6R concentrations and the duration ofincreased sIL-6R. The mean sIL-6R levels returned to baseline values atDay 29, Day 36, Day 57 and at follow-up for the 0.3, 1, 3 and 6 mg/kgdose groups respectively.

Mean sIL-6R levels of the placebo group did not show a clinicallyrelevant change from baseline.

DAS28 Score

The 28 joints assessed for Disease activity score using 28 joint counts(DAS28 score) included the proximal interphalangeal joints of thefingers, the interphalangeal joints of the thumbs, the 10metacarpophalangeal joints, plus the wrists, elbows, shoulders andknees. The DAS28 score is a validated index that combines the tender andswollen joint counts, CRP, and patient global assessment of diseaseactivity.

In order to calculate the DAS28 score, each of the 28 joints wereevaluated for tenderness and swelling. The DAS28 score was derived fromthe following formula:

DAS28=0.56*sqrt(TEN28)+0.28*sqrt(SW28)+0.36*Ln(CRP+1)+0.014*GH+0.96

sqrt=square root

TEN28=28 joint count for tenderness

SW28=28 joint count for swelling

Ln(CRP)=natural logarithm of CRP

GH=patient's global assessment of disease activity on a VAS of 0-100 mm.

The DAS28% change from baseline, measured at Day 57 and at follow-up,showed an improvement upon single dose administration of IL6R304, at alldose levels tested (Table B-9).

TABLE B-9 Summary of DAS28 Score Cohort Time after DAS score Placebo (N= 8) IL6R304 (N = 20) 0.3 mg/kg DAY 1 Pre-dose n 2 2 Moderate disease 1(50.0%) 1 (50.0%) High disease activity 1 (50.0%) 1 (50.0%) DAY 57 n 2 2Low disease activity 0 (0.0%) 1 (50.0%) Moderate disease 1 (50.0%) 1(50.0%) High disease activity 1 (50.0%) 0 (0.0%) FOLLOW UP n 2 2Moderate disease 0 (0.0%) 2 (100.0%) High disease activity 2 (100.0%) 0(0.0%) 1 mg/kg DAY 1 Pre-dose n 2 6 Low disease activity 0 (0.0%) 1(16.7%) Moderate disease 2 (100.0%) 4 (66.7%) High disease activity 0(0.0%) 1 (16.7%) DAY 57 n 2 6 Remission 1 (50.0%) 1 (16.7%) Low diseaseactivity 0 (0.0%) 3 (50.0%) Moderate disease 1 (50.0%) 2 (33.3%)FOLLOW-UP n 2 6 Remission 0 (0.0%) 1 (16.7%) Low disease activity 1(50.0%) 1 (16.7%) Moderate disease 1 (50.0%) 4 (66.7%) 3 mg/kg DAY 1Pre-dose n 2 6 Low disease activity 0 (0.0%) 1 (16.7%) Moderate disease2 (100.0%) 1 (16.7%) High disease activity 0 (0.0%) 4 (66.7%) DAY 57 n 25 Remission 0 (0.0%) 1 (20.0%) Moderate disease 2 (100.0%) 4 (80.0%)FOLLOW-UP n 2 6 Remission 0 (0.0%) 2 (33.3%) Moderate disease 2 (100.0%)3 (50.0%) High disease activity 0 (0.0%) 1 (16.7%) 6 mg/kg DAY 1Pre-dose n 2 6 Low disease activity 1 (50.0%) 0 (0.0%) Moderate disease1 (50.0%) 3 (50.0%) High disease activity 0 (0.0%) 3 (50.0%) DAY 57 n 26 Remission 0 (0.0%) 2 (33.3%) Low disease activity 1 (50.0%) 2 (33.3%)Moderate disease 1 (50.0%) 2 (33.3%) FOLLOW-UP n 2 6 Low diseaseactivity 1 (50.0%) 1 (16.7%) Moderate disease 1 (50.0%) 5 (83.3%)DAS28 > 5.1: high disease activity; 3.2 <= DAS28 <= 5.1: moderatedisease activity; DAS28 < 3.2: low disease activity; DAS28 < 2.6:remission.

The duration of improvement of DAS28 exceeded the duration of CRPreduction for all dose groups, indicating that the effect of IL6R304 onclinical activity persisted beyond its effect on the CRP biomarker (FIG.5; FIG. 8).

EULAR Response

The EULAR response criteria assess individual changes in DAS28 scoreduring a clinical study. The EULAR response criteria are defined inTable B-10.

TABLE B-10 EULAR Response Improvement in DAS28 Score Relative toBaseline Present DAS28 >1.2 0.6-1.2 <0.6 <3.2 good response moderateresponse no response 3.2-5.1 moderate response moderate response noresponse >5.1 moderate response no response no response

The EULAR scores indicated an improvement upon single doseadministration of IL6R304, at all dose levels tested (Table B-11).

TABLE B-11 Summary of EULAR Response (Safety Population) Cohort Timeafter dosing EULAR response Placebo* IL6R304 0.3 mg/kg DAY 57 n 2 2 GOOD0 (0.0%) 1 (50.0%) MODERATE 1 (50.0%) 1 (50.0%) NO 1 (50.0%) 0 (0.0%)FOLLOW UP n 2 2 MODERATE 0 (0.0%) 2 (100.0%) NO 2 (100.0%) 0 (0.0%) 1mg/kg DAY 57 n 2 6 GOOD 1 (50.0%) 1 (16.7%) MODERATE 0 (0.0%) 3 (50.0%)NO 1 (50.0%) 2 (33.3%) FOLLOW UP n 2 6 GOOD 2 (100.0%) 1 (16.7%)MODERATE 0 (0.0%) 4 (66.7%) NO 0 (0.0%) 1 (16.7%) 3 mg/kg DAY 57 n 2 5GOOD 0 (0.0%) 1 (20.0%) MODERATE 1 (50.0%) 4 (80.0%) NO 1 (50.0%) 0(0.0%) FOLLOW UP n 2 6 GOOD 0 (0.0%) 2 (33.3%) MODERATE 2 (100.0%) 2(33.3%) NO 0 (0.0%) 2 (33.3%) 6 mg/kg DAY 57 n 2 6 GOOD 0 (0.0%) 3(50.0%) MODERATE 0 (0.0%) 2 (33.3%) NO 2 (100.0%) 1 (16.7%) FOLLOW UP n2 6 MODERATE 0 (0.0%) 4 (66.7%) NO 2 (100.0%) 2 (33.3%) Overall* DAY 57n 8 GOOD 1 (12.5%) MODERATE 2 (25.0%) NO 5 (62.5%) FOLLOW UP n 8 GOOD 2(25.0%) MODERATE 2 (25.0%) NO 4 (50.0%) *all placebo

PK/PD Interim Analysis

IL6R304, sIL-6R and fibrinogen levels were modeled by nonlinear mixedeffects modeling using NONMEM version 7.1.0 double precision (ICONDevelopment Solutions, South County Business Park Leopardstown Dublin18, Ireland).

The approach used for the interim analysis was sequential: first apharmacokinetic model was developed to describe the drug IL6R304profiles, then the individual predicted pharmacokinetic parameters wereused as an input to the sIL-6R PK/PD model.

Pharmacokinetic Model

The estimation method used in the pharmacokinetic model was the firstorder conditional estimation with interaction (FOCEI). Prior tomodeling, the drug levels were log-transformed. An exponential errormodel (additive in the log scale) was assumed for residual variability.

In the study population, the pharmacokinetics of IL6R304 were adequatelycharacterized by a bi-compartmental model with a linear (non-targetrelated) and non-linear (target related) clearance from the centralcompartment. Bodyweight was found as a significant covariate onclearance and was included allometrically in the pharmacokinetic model.

An indirect response model with a sigmoidal inhibitory effect on theelimination of the drug-target complex was used to relate IL6R304 plasmalevels to the total sIL-6R plasma concentrations.

Overall, the estimated parameters were in good agreement with theparameters scaled from pre-clinical species and used for the dose-rangeselection of the clinical trial. The estimated I_(max) was 94%, and theIC₅₀ 68 ng/mL. The only parameter which differed significantly fromthose previously used was the V_(max) of the nonlinear clearancecomponent of the model, currently found three times lower. This violatedthe earlier made assumption in which V_(max) for IL6R304 was expected tobe similar to V_(max) for TCZ, due to the similar potency of thecompounds to bind sIL-6R (in-house data).

The pharmacokinetic consequence of this finding is that the exposure tothe drug is more prolonged than initially expected, and supports theevaluation of less frequent dosing regimens. The parameters derived fromthis model allowed to simulate the levels of IL6R304 expected afterrepeated dosing following various IL6R304 dosing regimens.

sIL-6R PK/PD Model

The estimation method used in the sIL-6R PK/PD model was the first orderconditional estimation (FOCE). Non-transformed data were used, and anadditive error model was assumed for residual variability.

An indirect PK/PD model of inhibition of plasma sIL-6R eliminationadequately captured the observed biomarker profiles.

In this indirect response model, the rate of change of sIL-6R (Response,R) is described by:

$\frac{dR}{dt} = {{Kin} - {{Kout}*\left\lbrack {1 - {{Imax}*\frac{C^{n}}{{{IC}\; 50^{n}} + C^{n}}}} \right\rbrack*R}}$

With k_(in), the zero-order synthesis rate; R, the plasma sIL-6R level,I_(max), the maximum inhibition (1<I_(max)<0); C, the concentration ofIL6R304; IC50, the IL6R304 concentration at which half of the maximumeffect is observed; n, the concentration-response shape factor; andk_(out), the first order elimination rate constant of plasma sIL-6R.

The parameters derived from this model allowed to simulate the levels ofsIL-6R expected following various IL6R304 dosing regimens.

Simulations

The PK and PK/PD models developed on the data available from the SADpart of the clinical trial were used to predict the expected exposureand biomarker profiles after repeated administration of the doses/dosingregimens proposed for the MAD part of the study. The prolongedpharmacokinetic and pharmacodynamic profiles suggested that differentdosing regimens as those initially planned could be used. With anestimated t_(1/2) of 17 d (similar to that of albumin), thepharmacokinetic profile of IL6R304 was expected to allow for a Q4W orQ8W dosing regimen. Three dose levels/regimens were selected for the MADphase of the study:

-   -   1 mg/kg Q4W    -   3 mg/kg Q4W    -   6 mg/kg Q8W

The PK/PD model developed to describe the IL6R304/sIL-6R relationship,and the ones back-engineered from TCZ models reported in the literature(Levi et al. 2012, J. Clin. Pharmacol. February 14. [Epub ahead ofprint]; Gibiansky and Frey 2012, J. Pharmacokinet. Pharmacodyn.39(1):5-16; Zhang and Peck 2011, Expert Rev. Clin. Pharmacol. 4(5):539-55) were used to simulate the expected biomarker levels and clinicalresponse during the MAD part of the study at the selected dose-regimens,and to compare them with TCZ. IL6R304 plasma levels of 1000 typicalindividuals expected after repeated drug administration were simulated,together with the corresponding sIL-6R profiles. FIGS. 2 and 3illustrate respectively the median IL6R304 and sIL-6R profiles expectedat the three proposed doses/dosing regimens.

The effects expected at a dose of 6 mg/kg Q8W IL6R304 would becomparable to TCZ 8 mg/kg, while an improved effect is expected at adose of 3 mg/kg Q4W.

Discussion:

The pharmacokinetic profiles of IL6R304 observed in this first clinicaltrial appeared more sustained than predicted based on preclinical datafrom monkeys, allometrically scaled, and combined with reasonableassumptions.

This discrepancy between the observed and the model-based simulations ofIL6R304-time profiles was attributed to an estimated 3-fold lower Vmaxof the non-linear clearance pathway relative to that anticipated basedon preclinical data (4.5 μg/h·kg) (see Table B-3).

Conclusions for the SAD Study:

Single i.v. administration of IL6R304 up to 6 mg/kg was safe and welltolerated in RA patients.

No deaths or treatment-related serious adverse events (SAEs) occurred,and a maximum tolerated dose (MTD) has not been reached.

The pharmacokinetics of IL6R304 appear non-linear, due to a saturabletarget-dependent CL component. However the exposure to the drug is moresustained than expected, due to a target-mediated clearance lessefficient than predicted from preclinical data and clinical data fromTCZ.

The corresponding biomarker profiles (sIL-6R) appear consequently alsomore prolonged than expected. An almost complete inhibition of theelimination of sIL-6R is predicted leading to sIL-6R levels in the rangeor higher than the target level of 400 ng/mL.

TABLES

TABLE A-1Protein sequences of improved Nanobodies (with FR and CDR sequences indicated)SEQ SEQ SEQ SEQ SEQ SEQ Nanobody ID FR1 ID CDR 1 ID FR2 ID CDR 2 ID FR3ID PMP7F4 7 EVQLVESGGGLVQPGGSL 11 VNVMA 18 WYRQAPGKG 20 GIINGGSTTYAD 27RFTISRDNAKNTLYLQM 29 RLSCAASGTTFK RELVA SVKG NSLRPEDTAVYYCAF PMP7C4 2EVQLVESGGGLVQPGGSL 12 INVMA 18 WYRQAPGKG 20 GIITNGSTSYAD 22RFTISRDNAKNTLYLQM 29 RLSCAASGTTFR RELVA SVKG NSLRPEDTAVYYCAF PMP7D6 3EVQLVESGGGLVQPGGSL 13 VNVMA 18 WYRQAPGKG 20 AVINGGTTTYA 23RFTISRDNAKNTLYLQM 29 RLSCAASGSIFR RELVA DSVKG NSLRPEDTAVYYCAF PMP7G7 4EVQLVESGGGLVQPGGSL 11 INIMA 19 WYRQAPGKG 20 GVITGGNTTYA 24RFTISRDNAKNTLYLQM 29 RLSCAASGTTFK RELVA DSVKG NSLRPEDTAVYYCAF PMP7G8 5EVQLVESGGGLVQPGGSL 14 INVMA 17 WYRQAPGKG 20 GVINDGSTTYA 25RFTISRDNAKNTLYLQM 29 RLSCAASGSTFR RELVA DSVKG NSLRPEDTAVYYCAF PMP20F6 6EVQLVESGGGLVQPGGSL 15 INVMA 17 WYRQAPGKG 20 GIVSGGSTSYA 26RFTISRDNAKNTLYLQM 29 RLSCAASGSVFK RELVA DSVKG NSLRPEDTAVYYCAF PMP20A11 1EVQLVESGGGLVQPGGSL 15 INVMA 17 WYRQAPGKG 20 GIISGGSTSYAD 21RFTISRDNAKNTLYLQM 29 RLSCAASGSVFK RELVA SVKG NSLRPEDTAVYYCAF PMP20E10 8EVQLVESGGGLVQPGGSL 15 INVMA 17 WYRQAPGKG 20 GIVSGGSTSYA 26RFTISRDNAKNTLYLQM 29 RLSCAASGSVFK RELVA DSVKG NSLRPEDTAVYYCAF PMP21A10 9EVQLVESGGGLVQPGGSL 16 INVMA 17 WYRQAPGKG 20 GIVTGGSTSYA 28RFTISRDNAKNTLYLQM 29 RLSCAASGSIFK RELVA DSVKG NSLRPEDTAVYYCAF PMP21D1110 EVQLVESGGGLVQPGGSL 15 INVMA 17 WYRQAPGKG 20 GIVTGGSTSYA 28RFTISRDNAKNTLYLQM 29 RLSCAASGSVFK RELVA DSVKG NSLRPEDTAVYYCAF SEQ SEQNanobody CDR 3 ID FR4 ID PMP7F4 VTTNSDYD 32 WGQGT 33 LGRDY LVTVSS PMP7C4VTTNSDYD 32 WGQGT 33 LGRDY LVTVSS PMP7D6 VTTNSDYD 32 WGQGT 33 LGRDYLVTVSS PMP7G7 VTTNSDYD 32 WGQGT 33 LGRDY LVTVSS PMP7G8 VTTNSDYD 32 WGQGT33 LGRDY LVTVSS PMP20F6 ITTNSDYDL 31 WGQGT 33 GRRY LVTVSS PMP20A11ITTESDYDL 30 WGQGT 33 GRRY LVTVSS PMP20E10 ITTESDYDL 30 WGQGT 33 GRRYLVTVSS PMP21A10 ITTESDYDL 30 WGQGT 33 GRRY LVTVSS PMP21D11 ITTESDYDL 30WGQGT 33 GRRY LVTVSS

TABLE A-2 Protein sequences of improved Nanobodies PMP7F4, SEQ ID NO: 7EVQLVESGGGLVQPGGSLRLSCAASGTTFKVNVMAWYRQAPGKGRELVAGIINGGSTTYADSVKGRFTISRDNAKNTLYLQMNSLRPEDTAVYYCAFVTT NSDYDLGRDYWGQGTLVTVSSPMP7C4, SEQ ID NO: 2 EVQLVESGGGLVQPGGSLRLSCAASGTTFRINVMAWYRQAPGKGRELVAGIITNGSTSYADSVKGRFTISRDNAKNTLYLQMNSLRPEDTAVYYCAFVTT NSDYDLGRDYWGQGTLVTVSSPMP7D6, SEQ ID NO: 3 EVQLVESGGGLVQPGGSLRLSCAASGSIFRVNVMAWYRQAPGKGRELVAAVINGGTTTYADSVKGRFTISRDNAKNTLYLQMNSLRPEDTAVYYCAFVTT NSDYDLGRDYWGQGTLVTVSSPMP7G7, SEQ ID NO: 4 EVQLVESGGGLVQPGGSLRLSCAASGTTFKINIMAWYRQAPGKGRELVAGVITGGNTTYADSVKGRFTISRDNAKNTLYLQMNSLRPEDTAVYYCAFVTT NSDYDLGRDYWGQGTLVTVSSPMP7G8, SEQ ID NO: 5 EVQLVESGGGLVQPGGSLRLSCAASGSTFRINVMAWYRQAPGKGRELVAGVINDGSTTYADSVKGRFTISRDNAKNTLYLQMNSLRPEDTAVYYCAFVTT NSDYDLGRDYWGQGTLVTVSSPMP20F6, SEQ ID NO: 6 EVQLVESGGGLVQPGGSLRLSCAASGSVFKINVMAWYRQAPGKGRELVAGIVSGGSTSYADSVKGRFTISRDNAKNTLYLQMNSLRPEDTAVYYCAFITT NSDYDLGRRYWGQGTLVTVSSPMP20A11, IL6R300, SEQ ID NO: 1EVQLVESGGGLVQPGGSLRLSCAASGSVFKINVMAWYRQAPGKGRELVAGIISGGSTSYADSVKGRFTISRDNAKNTLYLQMNSLRPEDTAVYYCAFITT ESDYDLGRRYWGQGTLVTVSSPMP20E10, SEQ ID NO: 8EVQLVESGGGLVQPGGSLRLSCAASGSVFKINVMAWYRQAPGKGRELVAGIVSGGSTSYADSVKGRFTISRDNAKNTLYLQMNSLRPEDTAVYYCAFITT ESDYDLGRRYWGQGTLVTVSSPMP21A10, SEQ ID NO: 9EVQLVESGGGLVQPGGSLRLSCAASGSIFKINVMAWYRQAPGKGRELVAGIVTGGSTSYADSVKGRFTISRDNAKNTLYLQMNSLRPEDTAVYYCAFITT ESDYDLGRRYWGQGTLVTVSSPMP21D11, SEQ ID NO: 10EVQLVESGGGLVQPGGSLRLSCAASGSVFKINVMAWYRQAPGKGRELVAGIVTGGSTSYADSVKGRFTISRDNAKNTLYLQMNSLRPEDTAVYYCAFITT ESDYDLGRRYWGQGTLVTVSS

TABLE A-3 Protein sequences of preferred polypeptides of the inventionIL6R304, SEQ ID NO: 34EVQLVESGGGLVQPGGSLRLSCAASGSVFKINVMAWYRQAPGKGRELVAGIISGGSTSYADSVKGRFTISRDNAKNTLYLQMNSLRPEDTAVYYCAFITTESDYDLGRRYWGQGTLVTVSSGGGGSGGGSEVQLVESGGGLVQPGNSLRLSCAASGFTFSSFGMSWVRQAPGKGLEWVSSISGSGSDTLYADSVKGRFTISRDNAKTTLYLQMNSLRPEDTAVYYCTIGGSLSRSSQGTLVTVSS IL6R305, SEQ ID NO: 35EVQLVESGGGLVQPGGSLRLSCAASGSVFKINVMAWYRQAPGKGRELVAGIISGGSTSYADSVKGRFTISRDNAKNTLYLQMNSLRPEDTAVYYCAFITTESDYDLGRRYWGQGTLVTVSSGGGGSGGGSEVQLVESGGGLVQPGGSLRLSCAASGSVFKINVMAWYRQAPGKGRELVAGIISGGSTSYADSVKGRFTISRDNAKNTLYLQMNSLRPEDTAVYYCAFITTESDYDLGRRYWGQGTLVTVSSGGGGSGGGSEVQLVESGGGLVQPGNSLRLSCAASGFTFSSFGMSWVRQAPGKGLEWVSSISGSGSDTLYADSVKGRFTISRDNAKTTLYLQMNSLRPEDTAVYYCTIGGSLSRSSQGTLVTVSS IL6R306, SEQ ID NO: 36EVQLVESGGGLVQPGGSLRLSCAASGSVFKINVMAWYRQAPGKGRELVAGIISGGSTSYADSVKGRFTISRDNAKNTLYLQMNSLRPEDTAVYYCAFITTESDYDLGRRYWGQGTLVTVSSGGGGSGGGSEVQLVESGGGLVQPGNSLRLSCAASGFTFSSFGMSWVRQAPGKGLEWVSSISGSGSDTLYADSVKGRFTISRDNAKTTLYLQMNSLRPEDTAVYYCTIGGSLSRSSQGTLVTVSSGGGGSGGGSEVQLVESGGGLVQPGGSLRLSCAASGSVFKINVMAWYRQAPGKGRELVAGIISGGSTSYADSVKGRFTISRDNAKNTLYLQMNSLRPEDTAVYYCAFITTESDYDLGRRYWGQGTLVTVSS

TABLE A-4 Preferred, but non-limiting examples of albumin-binding Nanobodies ALB-1, SEQ ID NO: 37AVQLVESGGGLVQPGNSLRLSCAASGFTFRSFGMSWVRQAPGKEPEWVSSISGSGSDTLYADSVKGRFTISRDNAKTTLYLQMNSLKPEDTAVYYCTIGG SLSRSSQGTQVTVSSALB-8(humanized ALB-1), SEQ ID NO: 38EVQLVESGGGLVQPGNSLRLSCAASGFTFSSFGMSWVRQAPGKGLEWVSSISGSGSDTLYADSVKGRFTISRDNAKTTLYLQMNSLRPEDTAVYYCTIGG SLSRSSQGTLVTVSSALB-2, SEQ ID NO: 39 AVQLVESGGGLVQGGGSLRLACAASERIFDLNLMGWYRQGPGNERELVATCITVGDSTNYADSVKGRFTISMDYTKQTVYLHMNSLRPEDTGLYYCKIRR TWHSELWGQGTQVTVSS

TABLE A-5 Sequence listing of linkers SEQ ID Linker NO: Sequences  5GS40 GGGGS  7GS 41 SGGSGGS GS8 42 GGGGSGGGS  9GS 43 GGGGSGGGS 10GS 44GGGGSGGGGS 15GS 45 GGGGSGGGGSGGGGS 18GS 46 GGGGSGGGGSGGGGGGGS 20GS 47GGGGSGGGGSGGGGSGGGGS 25GS 48 GGGGSGGGGSGGGGSGGGGSGGGGS 30GS 49GGGGSGGGGSGGGGSGGGGSGGGGSGGGGS 35GS 50GGGGSGGGGSGGGGSGGGGSGGGGSGGGGSGGGGS G1 51 EPKSCDKTHTCPPCP hinge 9GS-G152 GGGGSGGGSEPKSCDKTHTCPPCP hinge Llama 53 EPKTPKPQPAAA upper long hingeregion G3 54 ELKTPLGDTTHTCPRCPEPKSCDTPPPCPRCPEPK hingeSCDTPPPCPRCPEPKSCDTPPPCPRCP Ala 55 AAA

The entire contents of all of the references (including literaturereferences, issued patents, published patent applications, andco-pending patent applications) cited throughout this application arehereby expressly incorporated by reference, in particular for theteaching that is referenced herein.

EQUIVALENTS

The foregoing written specification is considered to be sufficient toenable one skilled in the art to practice the invention. The presentinvention is not to be limited in scope by examples provided, since theexamples are intended as an illustration of certain aspects andembodiments of the invention. Other functionally equivalent embodimentsare within the scope of the invention. Various modifications of theinvention in addition to those shown and described herein will becomeapparent to those skilled in the art from the foregoing description andfall within the scope of the appended claims. The advantages and objectsof the invention are not necessarily encompassed by each embodiment ofthe invention.

What is claimed is:
 1. A method for inhibiting IL-6 mediated signalingin a subject comprising administering to the subject a polypeptide thatspecifically binds IL-6R and that consists of SEQ ID NO: 34, wherein theamount of the polypeptide administered is effective: to increase totalsIL-6R levels in serum to at least 400 ng/ml and to maintain totalsIL-6R levels in serum at at least 400 ng/ml; to increase total IL-6levels in serum to at least 40 pg/ml and to maintain total IL-6 levelsin serum at at least 40 pg/ml; to reduce CRP levels in serum below 10mg/l and to maintain CRP levels in serum below 10 mg/l; to reduce CRPlevels in serum by 50% or more compared to baseline (i.e. pre-treatmentor normal) levels and to maintain CRP levels in serum at 50% or morereduction compared to baseline levels; to reduce ESR levels in serum by30% or more compared to baseline (i.e. pre-treatment or normal) levelsand to maintain ESR levels in serum at 30% or more reduction compared tobaseline levels; to reduce fibrinogen levels in serum by 30% or morecompared to baseline (i.e. pre-treatment or normal) levels and tomaintain fibrinogen levels in serum at 30% or more reduction compared tobaseline levels; and/or to reduce serum amyloid A levels by 30% or morecompared to baseline (i.e. pre-treatment or normal) levels and tomaintain serum amyloid A levels at 30% or more reduction compared tobaseline levels; and wherein the polypeptide is administered in anamount from 1 mg/kg to 10 mg/kg every 2 to 4 weeks. 2.-14. (canceled)15. The method of claim 1, wherein the subject is suffering from adisease and/or disorder selected from sepsis, cancer (such as multiplemyeloma disease (MM), renal cell carcinoma (RCC), plasma cell leukaemia,lymphoma, B-lymphoproliferative disorder (BLPD) and prostate cancer),bone resorption (osteoporosis), cachexia, psoriasis, mesangialproliferative glomerulonephritis, Kaposi's sarcoma, AIDS-relatedlymphoma, an inflammatory disease and/or disorder (such as rheumatoidarthritis, systemic onset juvenile idiopathic arthritis,hypergammaglobulinemia, Crohn's disease, ulcerative colitis, systemiclupus erythematosus (SLE), multiple sclerosis, Castleman's disease, IgMgammopathy, cardiac myxoma, asthma (in particular allergic asthma) andautoimmune insulin-dependent diabetes mellitus).
 16. The method of claim1, wherein the subject is suffering from rheumatoid arthritis.
 17. Themethod of claim 1, wherein the polypeptide is administered in an amountfrom about 1 mg/kg to about 2 mg/kg.
 18. The method of claim 17, whereinthe polypeptide is administered in an amount of about 1 mg/kg. 19.(canceled)
 20. The method of claim 17, wherein the polypeptide isadministered in an amount of about 2 mg/kg.
 21. The method of claim 1,wherein the polypeptide is administered in an amount from about 3 mg/kgto about 6 mg/kg.
 22. The method of claim 21, wherein the polypeptide isadministered in an amount of about 3 mg/kg.
 23. The method of claim 21,wherein the polypeptide is administered in an amount of about 6 mg/kg.24.-196. (canceled)
 197. The method of claim 1, wherein the polypeptideis administered as a multiple dose.
 198. (canceled)
 199. The method ofclaim 197, wherein the polypeptide is administered every 4 weeks. 200.The method of claim 199, wherein the polypeptide is administered atabout 3 mg/kg every 4 weeks.
 201. The method of claim 199, wherein thepolypeptide is administered at about 6 mg/kg every 4 weeks.
 202. Themethod of claim 197, wherein the polypeptide is administered every 2weeks.
 203. The method of claim 202, wherein the polypeptide isadministered at about 1 mg/kg every 2 weeks. 204.-238. (canceled)